Category Archives: tbiscc

A proposal for NY State’s TBI Waiver: Elephant #1: Lack of knowledge about the brain: a Remedy

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We have thus far identified the four parts of this proposal. In short they are the three elephants in the room and a summation with final thoughts.

Part 1:  Elephant #1: Lack of knowledge about the brain

Part 2:  New York State Traumatic Brain Injury Services Coordinating Council

Part 3: Elephant #3: Lack of effective oversight of those providing services to those on the waiver, a problem which is severely exacerbated by Elephant #1

Part 4: Summation and final thoughts

The proposal format for Elephant #1 is being published in two parts. The first part, the outlining of the problem or challenge, was published yesterday, and this is the second part, a proposed remedy to the issues outlined in part 1. I had thought elephants #2 and #3 would need to be addressed in two parts, but they may be able to be successfully addressed in one part. We’ll see.

Let me say that not for a minute do I think the remedy, as set forth here, is in any way perfect nor am I claiming that it can’t be improved on. It can, and it should be. What I believe is that the remedy I am about to describe here is a solid step in the right direction and, if it is applied, it will, in addition to dramatically benefitting the lives of those men and women with brain injuries currently on New Yorks TBI (Traumatic Brain Injury) Waiver and the lives of future waiver participants, save Medicaid dollars, a lot of them, to put it mildly.

Thus far I have, I hope, successfully outlined some salient points. First, as the current waiver molds into its new form, decision makers must be very careful not to discard the plethora of waiver staff and others (RRDCs) who have, over time, developed an understanding of the brain and brain injury that is rare in general and rare in the over-worked folds of managed care companies. Second, anyone providing and or monitoring/regulating waiver services must be trained and deserves to be trained to a level of expertise that is currently sorely lacking. Third, there can be no doubt that truly well-trained waiver staff, RRDCs and DOH staff, will create a program and delivery of services that will result far more positive outcomes and save money to boot. Brain Injury 101, which is offered by the Brain Injury Association of New York State (BIANYS) free of charge, is excellent for those seeking a cursory overview of the brain, but it does not provide the level of knowledge needed and deserved by those providing waiver services nor those overseeing and regulating them.

However, BIANYS has staff qualified to train individuals to become a CBIS (Certified Brain Injury Specialist) or a CBIST (Certified Brain Injury Specialist Trainer). The CBIST is qualified to train people to the CBIS level of expertise. Both CBIS and CBIST are offerings linked to ACBIS, the Academy of Certified Brain Injury Specialists.

Now, I am anything but oblivious to the fact that Medicaid dollars, any dollars for that matter, are in short supply. There is a fee for each person sent for CBIS or CBIST training, something in the neighborhood of $300 per individual. Even if a reimbursement rate for staff training is instituted, and it must be if this program is ever to reach its full potential and save money in the process, $300 per individual is far too costly for providers. So, here is what I propose.

  • Identify some key staff members who meet the criteria for becoming CBISTs as set forth by ACBIS, and send them for the training.
  • Once they are CBISTs, they are then able to train staff to a CBIS level of expertise. No, ACBIS will not be issuing certificates because no fees were paid, but yes, staff will be at a significantly higher level of expertise and, to my knowledge, there is nothing preventing providers or the RRDCs or the DOH from issuing certificates of achievement to those staff members who have reached the CBIS level of expertise.

Were this proposal to be enacted, waiver programs would operate at a markedly higher level of expertise, waiver participants would benefit greatly, and, in the long run, would require less services to maintain and increase their independence, which is, after all, the point of the waiver in the first place.

Now, I think at some point the DOH must make this level of training mandatory, but not until one of two things happen. There is either a reimbursement rate instituted for staff training that, I have neglected to say until now, must be relevant to those who live with brain injuries, or, there is a higher reimbursement rate awarded for waiver services once the training is successfully completed.

 

Please distribute to all interested parties

 

Next: Elephant #2: New York State Traumatic Brain Injury Services Coordinating Council

A proposal for NY State’s TBI Waiver: Elephant #1: Lack of knowledge about the brain: The Challenge

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As discussed in the preceding blog post, this is Part 1 of what will ultimately be a four-part proposal for the New York State’s Traumatic Brain Injury Medicaid Waiver. The first three parts of this proposal will each be published in two segments. The first segment will outline the problem, the second segment will offer a remedy. The fourth part of the proposal will be a summation, along with some final thoughts. I would urge my readers to please share this proposal with all interested parties. If, in your respective journeys, you hear people say it is too late or too soon or its impossible to do anything or change anything, you might want to remind them that there is no time like the present to improve things and, as for any of this proposal being impossible, perhaps they should pause for a moment to consider what it is like for those who are trying taking part in life again when they can’t walk, talk, think, or remember the way you used to. Nothing that will be proposed here is impossible.

The four parts of this proposal, and with a tip of the hat to the phrase, there are three elephants in the room, are:

Part 1) Elephant #1: Lack of knowledge about the brain

Part 2) Elephant #2: The New York State Traumatic Brain Injury Services Coordinating Council

Part 3) Elephant #3: Lack of effective oversight of those providing services to those on the waiver, a problem which is severely exacerbated by Elephant #1

Part 4) Summation and final thoughts

I am encouraging readers to understand that what I am setting down here is rooted in two facts: I worked in the field of brain injury for nearly 20 years and I’ve lived with a brain injury that will, this August 24th,  celebrate it’s 28th birthday. Over nearly 30 years I have seen agencies that care and agencies that don’t. I’ve seen department of health officials who care and those who don’t. I’ve seen groups and individuals that advocate with their heart and soul and I’ve seen groups and individuals that say they are advocates and they are not. Moreover, I’ve seen individuals and groups who are so sadly self-absorbed that they will gladly  and boisterously support a proposal, if and only if, they can figure out a way to claim the proposal is theirs. And, if someone sees something in this proposal they like and they want to claim it is their idea, that’s fine by me. I don’t care whose idea it is. What I care about, and, what I believe most involved with the TBI Waiver care about (and yes, with some exceptions, I am including  those in the DOH), is that the state’s TBI Waiver, whatever its ultimate form, provides New Yorkers with brain injuries with the kind of services that give them the best chance of reaching their maximum level of independence.

 

Elephant #1: Lack of knowledge about the brain

 

Note: You will hear me talk about how those providing waiver services have, over time, developed a level of knowledge about the brain that is far superior to those in managed care companies (and many others). This  should in no way be seen as a contradiction of the assertion that a lack of knowledge about the brain is a rather global problem. Many waiver staff have learned as a result of their individual efforts and as a result of employers who, when able, will take the financial hit that comes with sending a few of their employees to at least some training. The need to increase knowledge of the brain on all fronts, including (and in fairness to) the state’s department of health, is very real.

The good news (and it truly is good news), is this: the majority of companies providing waiver services (we’ll call them waiver providers) are trying with all their might to provide the best services possible, but they are doing so without being able to give their staff the proper training because, in most cases, it is far too costly.  There is no reimbursement for staff training and there needs to be. Those who say it is up to the provider to do this on their dime are just plain wrong. It is simply too expensive. Moreover, there can be no argument that properly trained staff mean a more effective delivery of services and, as a result, those receiving the services will experience outcomes that will grow their independence and thus reduce their need for services, which, for the bean counters, means Medicaid dollars saved.

The way things stand now if a waiver provider wants to send five staff members at a time for training, they must pay the staff while they’re going through training. The waiver provider may or may not have other staff that can do the work of the staff in training. Yet, in some cases, when it comes to counseling services, this strategy would be therapeutically irresponsible.

Lack of knowledge about the brain can and often does result in waiver participants receiving more services than they really need. Lack of knowledge about the brain also provides the less ethical waiver providers – and they know who they are – with an excuse to engage in community-based warehousing, a trend that would be much harder to hide were staff better trained and providers held to a higher training standard.

Right now the lack of knowledge about the brain is leading decision makers to consider changes in waiver services that would be dangerous for waiver participants and, in some cases, stop some people with brain injuries from ever rejoining the community while causing others, now living in the community, to be placed in nursing homes. This is not an overstatement.

Let me be specific:

HCSS (Home and Community Support Services): HCSS staff provide services that help waiver participants manage life in the community with the minimal support necessary for doing so. Apparently, cutting these services dramatically and or entirely is under consideration, the thought being to replace HCSS staff with PCAs, personal care assistants, who are trained to provide a higher level of  care (hands on when necessary). Hands on care is  not needed by many of the waiver participants now receiving HCSS services. There is a gaping flaw in the reasoning behind what is being considered here that can be directly attributed to a lack of knowledge about the brain.

  • What will happen to waiver participants who require no hands on care but who live with a memory (cognitive) deficit that will stop them from finding their way home if they leave their house?
  • What will happen to the waiver participant who has, let us say, no problem whatsoever writing down his or her shopping list but, when they enter the supermarket, the lights and noise and physical activity will be cognitively overwhelming and, were it not to the presence of an HCSS staff member, the shopping trip would not reach a successful conclusion?
  • What will happen to the waiver participant who, in addition to living with his or her brain injury, lives with PTSD  and, as a result,I s unable to leave their home and go for walks or community excursions without an HCSS staff member?

None of the above scenarios requires hands on care, i.e., someone with a PCA level of training. To remove HCSS from the mix would be dangerous and would signal a worsening of services. It would also result in the end of independence for many and the end of a chance at independence for many others.

 

CIC (Community Integration Counseling): CIC is a form of psychotherapy designed to help a waiver participant manage the experience of living life with a brain injury.

  • Any cuts or caps currently being considered to this service are dangerous and, again, very likely a result of the lack of  knowledge decision makers have of the brain. First, the idea of removing CIC as a waiver offering and handing it over to a managed care company is essentially throwing the baby out with the bath water. There are CICs across the state who over time have developed a really admirable knowledge and understanding of people who live with brain damage, to remove them from the mix is a step backwards. There is little enough knowledge of brain injury in the first place, don’t remove or displace those that have the knowledge that is so desperately needed. The shortage of those who understand the brain is severe enough, there is no healthy reason to make it worse.
  • The idea of limiting CIC, requiring that it end at some point, is another example, albeit an understandable one, of decision makers not understanding the brain. The following point is critically important for everyone to understand, to fully grasp. A brain injury is not, I repeat, not a fixed thing. It is not static. For the person with a brain injury it is one experience when they are rested, often another experience when they are tired. The role a brain injury plays in one’s life changes over time. From 1995 to about 2004 I was able to work full-time hours and then some. On or about 2004, that changed. Fatigue became a factor, and, for the first time, a marked sensitivity to noise emerged. I had arrived at a place where I could maybe work 10 or 12 hours a week at most. Dealing with change like this is a formidable emotional ride, which is why CICs are so deeply important, and why no one but the CIC and the waiver participant should be deciding when or if the therapy should end.
  • The idea of ridding the waiver of CICs altogether is, like that of slashing or ending HCSS, or, for that matter, Service Coordination (Case Managers), a bad one. It will be discarding a slew of people across the state who have a far better understanding of the challenges faced by those living with brain damage than any of their perspective counterparts in  managed care companies.

Service Coordination (Case Managers): Service Coordinators, the waivers term for case managers, work with a waiver participants to help them identify and utilize the services that would best support their quest for independence. Like other waiver service providers, CICs, the Behaviorists, and so on, these Service Coordinators have, over time, developed a working knowledge of the brain that is far superior to any of the case managers in managed care companies who, by the way, are burdened with case loads that are, in brief, largely inhumane. Once again, these Service Coordinators are a valuable resource, to discard them would be, in short, a disaster.

Regional Resource Development Centers (RRDCs): RRDCs are agencies under contract with the state’s DOH to oversee waiver providers and participants in specific regions throughout the state. Some RRDCs are superb (Southern Tier Independence Center out of Binghamton and the Southern Adirondack Independent Living Center out of Queensbury, to name two), some are not. To remove the RRDCs from the picture and hand their work over to managed care companies would  be a disaster. The good RRDCs have a working knowledge of the brain and the waiver itself that far exceeds anything a managed care company can bring to the table; it is not even close.

In other words, to sum up this portion of the proposal, decision makers must be careful not to discard those that have, through hard work and experience, accrued a real knowledge of brain injuries and those that live with them. The notion that informed waiver service providers are  important resources applies to all the waiver services, not just those mentioned here.

***

Moving on.

Imagine, if you will, two scenarios that quite a few waiver participants have experienced.

Scenario #1: You’ve had a stroke or been in a car accident and your head hit the windshield. As a result, you find that you still think as clearly as ever but every time you try to talk you have trouble putting the words together.

Scenario #2: As a result of a stroke or car accident, you find that you have the same desire you always did to keep your house clean or go for long walks or go to the gym, but you just can’t get yourself to do or finish any of these things.

Scenario #1 describes someone who is dealing with what’s called expressive aphasia. There is likely due to damage to an area on the left side of the brain’s front lobe called the Broca’s Area. It is there that the brain provides you with the ability to accurately say what you want to say. When it is damaged, the person is thinking as well as they ever did but their ability to say what they want to say is damaged. Scenario #2 describes a symptom attributed to frontal lobe damage wherein the person is telling the truth when they say they want to cook a meal or go for a walk and go to the gym, but the internal ignition, as it were, is not there, or, the “fuel” needed to complete the task is not there. It’s as if you were sitting in the driver’s seat of a car your loved but the car had no ignition, or no fuel, or, was absent both.

 

Structured Day Programs (SDPs): If there is any waiver service that finds itself in the arena of being overprescribed, it is structured day. When well run, and they often are,  these programs are critically important and very helpful. I’ve seen the structured day program offered by RES, a waiver provider in Long Island, and it is, in a word, spectacular. Living Resources in Albany is excellent. The same can be said of the structured day program that was offered at the Cortland Community Re-Entry Program under the remarkable leadership of Joseph Abdulla. Sadly, Healthcare Associates, Inc., parent company to the Cortland program, dropped the ball, and the Cortland program is no more.

Having said this, some SDPs are prime examples of community-based warehousing and a blatant disregard for the rights of the participants and the realities of their injuries.

Let me first explain a reality faced by everyone who lives with brain damage. Simply put, part of your brain doesn’t work anymore which means the rest of your brain must pick up the slack. It has to work harder, in other words. A good analogy would be, you have a car with a six-cylinder engine. One of the cylinders stops working. The engine still runs, but it is now five cylinders are being asked to do the work of six. The fact that the injured brain is working harder is one of the primary reasons fatigue is a factor for many of us. Moreover, the brain itself has no nerve endings so, unlike your arms and legs who, bless them, will let you know when they’re tired, the brain won’t. You have to learn to read the signals as it were.

Some of the less ethical waiver providers don’t want their staff to learn more about the brain because they don’t want to reduce any services for anyone. As the wife of a man with a brain injury once told me, “The second my husband got his brain injury he became a cottage industry.” I remember becoming a CBIST (Certified Brain Injury Specialist Trainer) which meant I had the expertise to train others to CBIS (Certified Brain Injury Specialist) levels of expertise. The Albany-based provider I was working for at the time never once utilized my skills on this front and even scoffed at the CBIS training manual as being useless, never mind that the manual was thanks to the input of a wide range of neurologists, neuropsychologists, and so forth.

A frequent pattern in SDPs run by the less ethical waiver providers is as follows. Waiver participants are often expected to attend the SDP Monday through Friday and stay for the full five hours the waiver provider is legally allowed to bill for. Whether they attend five days a week or not, they and their clinicians are told that they cannot leave structured day to meet with a clinician. They can meet with the clinician during their (the participant’s) lunch hour, or at home in the evening. Why is this? The waiver provider doesn’t want to lose a single solitary hour of billing for structured day. Never mind that the participant will be exhausted in the evening, it doesn’t matter. I know of cases where participants arrive home, exhausted after a full day of structured day, only to have one to three hours of clinical time at home. And, if the participant finally says enough, stop, the provider will drag them in front of the RRDC claiming the participant is refusing the care they agreed to. Now imagine trying to defend yourself if, as described above, you had expressive aphasia.

These are some and by no means all of the challenges now being faced by New York State.

 

Please distribute to all interested parties

 

Next: Lack of knowledge about the brain – a remedy

 

Preview: Proposal for NY State’s TBI Waiver: the Three Elephants in the Room

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Although New York State is still reviewing it’s Traumatic Brain Injury Medicaid Waiver Program, one thing appears clear already, the waiver will be moved into managed care. The question is, will revisions to the structure of the waiver services  best serve the nearly 3,000 New Yorkers with brain injuries currently on the waiver, future waiver participants, and best serve the providers who are, in the majority of cases, trying with all their might to their level best?

The jury is still out.

Over the next week or so this blog will be offering a proposal that will be published in three parts. What will become of it will ultimately depend on several things: the commitment of government officials, the commitment of those who provide waiver services (the majority of them are superb, the question is will they be able to manage and, if necessary, expose the problem providers who are, thankfully, in the minority), the inclusion of people who live with brain injuries, their families, and advocates in the discussion, and, last but not least, the inclusion of persons who understand the brain: neuropsychologists like Albany-based Dr. Maria Lifrak, and neurologists.

Historically, this kind of inclusiveness has been missing.  And, while all parties say they are committed to providing the best services,  we all know that actions speak louder than words.

The waiver came to New York in 1995 as a result of the heartfelt efforts of people with brain injuries, their families, advocates, and, very much to their credit, health care professionals. It was clear then and even clearer now that many of us who live with a brain injury can, with varying degrees of support, remain in the community, and not, as all too often happened in the past, find ourselves tucked away in nursing homes. Furthermore, it costs less money to support someone in the  community than it does in a nursing home.

The phrase, the elephant in the room, is highly applicable here with a small revision: there are three elephants in the room. If the state truly addresses them, it will be able lift its head with justified pride, dramatically improve the services provided by the waiver, and save even more Medicaid dollars in the process. If the state, i.e., the powers that be, operates in a vacuum, meaning they might have held public hearings but the fix is in, life will get worse for New Yorkers with brain injuries, their families, and those who provide services to them.

Including all stakeholders in the program’s design (not just at public hearings) is a must. Doing so guarantees a program that will run with a higher degree of efficacy and dollars.

 

The Three Elephants

Elephant #1: Lack of knowledge about the brain on virtually all fronts.

Elephant #2: The New York State Traumatic Brain Injury Services Coordinating Council.

Elephant #3: Lack of effective oversight of those providing services to those on the waiver, a problem which is severely exacerbated by Elephant #1.

 

Next: Elephant #1

 

Note to reader: Please forward this blog piece and the upcoming proposal segments to all interested parties. Thank you!

Some thoughts on NY State’s TBI Council

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For several reasons, immoveable objects all, I will not be able to attend the meeting this Friday of the New York State Traumatic Brain Injury Services Coordinating Council (TBISCC). Given this, I thought I might offer a few thoughts about the council (the council agenda will be presented at the end of this missive).

There is no doubt that the TBISCC, were it blessed with healthy leadership, could play a very healthy role in the lives of New York State residents who live with brain injuries. There is certainly no harm, nor do I think anyone in the state’s Department of Health would be upset, were the council to live up to its mandate and offer healthy proposals so that the state might better support the right of those living with brain injuries to live as independently as possible.

In order for this to happen, the council must free itself of the self-absorbed rather unpleasant likes of Michael Kaplen. As an earlier piece in this blog explains, Kaplen’s term on the council expired in 2004 . This fact has not stopped Kaplen from acting as the council’s chair.  The council’s vice-chair, Judith Avner, saw her term expire in 2003, yet she too remains on the council.

Kaplen and Avner are wrong to continue in their current posts when their terms have long since expired. Council members need to step up and address the issue. This writer, as readers of this blog already know, thinks Kaplen needs to leave the world of brain injury altogether, the sooner the better. However, the council would benefit from Avner’s continued presence as a representative of the Brain Injury Association of NY State. She is their executive director. While I do not think BIANYS members ought to be on the council proper since BIANYS receives funding from the New York State Department of Health, I think it is critically important that BIANYS have a firm seat at the table as a non-voting council member, much like various state agencies do.

There are some good people on the council and, though we’ve clashed from time to time, there are some good people in the NY State DOH. This next meeting will be a litmus test for all. Will they allow Kaplen to just push on forward as if he is still the chair and say nothing? Or, will they hold him accountable, and dismiss him from the council, or, document he has been reappointed by God knows what fool, and then hold elections for the chair and vice-chair of the council?

If the council acts as if its business as usual, and Kaplen is allowed to remain at its head, then every single person in the room has brutally betrayed the very people they are pledged to serve, New York State residents who live with brain injuries and their families and friends.

 

 

TRAUMATIC BRAIN INJURY SERVICES COORDINATING COUNCIL

NYS Department of Health

875 Central Avenue, Albany, New York

(Main Conference Room)

Friday, April 20, 2012

10:30 AM – 3:30 PM

AGENDA

10:30am – 10:45am Welcome

Introduction of New Member

Review and Approval of Minutes from

September 12, 2011 Meeting

10:45am – 12:00pm New York State Five Year TBI Action Plan

Carla Williams, Deputy Director, Division of Long Term Care, NYSDOH

12:00pm – 1:15pm LUNCH (Members on their own)

1:15pm – 2:00pm Impact of MRT proposals on TBI and NHTD waivers:

Medicaid Managed Care and Repatriation of individuals served out of NYS

Jason Helgerson, Deputy Commissioner, Office of Health Insurance Programs and NYSDOH Medicaid Director

2:00pm – 2:30pm Update on Stakeholder Committee Discussion of Coordinated Medicaid Managed Care Program for Individuals with TBI

Joseph Vollaro, PhD.

2:30pm – 3:00pm Subcommittee reports

· Healthcare Reform/Non-Waiver Service Needs

· Public Awareness/ Injury Prevention and Information Dissemination

3:00pm – 3:30pm Public Comment/Summary/Next Steps/Adjournment

Michael Kaplen needs to go

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If I could flip a switch that would completely remove one person from the world of brain injury, Michael Kaplen would vanish.

Apparently, the fact his term on NY State’s Traumatic Brain Injury Services Coordinating Council ended in 2004, coupled with the fact elections appear to be way overdue for the position of council chair, a post he clings to like Linus clings to his blanket, means nothing. The agenda released for the TBISCC’s meeting on March 1 (see below) reveals Kaplen has no intention of addressing either of these issues. One  hopes council members and the New York State Department of Health will hold him accountable, even though doing so may result in a Kaplen hissy fit.

Living with a brain injury is a formidable challenge and then some. But we are not the only ones facing tough challenges.  The challenges the New York State Department of Health  faces in it relationship to services for New Yorkers with brain injuries are formidable to say the least. So too are the intensely formidable challenges the Brain Injury Association of NY State faces in its work. 

But here’s the difference. When I talk with BIANYS leaders like Judith Avner, the executive director, and Marie Cavallo, the president, there  are things we agree on and things we disagree on. What all three of us have in common is this; we all truly care. When I talk with Mark Kissinger, Deputy Commissioner for the DOH, and Mary Ann Anglin, a division director for the DOH, there are things we agree and disagree on. But again, what do we have in common? We all care.

I don’t believe for a millisecond that Michael Kaplen cares. I don’t think he cares about anything but Michael Kaplen. I can also tell you that if you ever want to speak with him and can’t find him, just take out a camera and he’ll appear before your eyes in a flash. One particular rather self-serving behavior of Kaplen’s provides, perhaps, a clue to what he is all about. Past BIANYS board members as well as this writer remember times at board meetings that he would go around the table and place a business card – from his law firm – at each person’s place at the table. One year at the NYS DOH’s Best Practice Conference, at a time when Kaplen was the BIANYS president, a couple of us noticed that he was going around the entire room, which seated 1,000 people if not more, placing business cards from his law firm on each and every table. To this day he may not know that I went around the room and, with the help of an ally, removed nearly all the cards.

It will surprise few, if any, that when the BIANYS board voted on a well-designed ethics policy, every board member voted in favor, except for Kaplen. He chose to abstain.

In my opinion, Kaplen is a bully. I have seen him threaten to embarrass every member of the BIANYS board of directors because there were some who had an opinion that differed from his. In fact, his behavior was so nasty,  the board had to break so some members could gather themselves. One board member, a woman with a brain injury who was at her first meeting,  was so frightened by Kaplen’s behavior she was shaking.

In one of the first TBISCC meetings I attended I watched an exchange between Kaplen and Mary Ann Anglin. Ms. Anglin was asking a series of perfectly reasonable questions. Kaplen could not have been more unpleasant or acted more put out if he’d gone to Actor’s Studio  to master the display of both conditions.

At another TBISCC meeting an American Veteran in attendance who lives with a brain injury asked a question of a presenter. The veteran was immediately pulled up short by Kaplen who sternly explained that now was not the time for him to be asking questions. When, moments later, two council members offered to give their time to the veteran so he could voice his question, Kaplen yelled at them. Like I said, he’s a bully, and like most bullies, he’s a wimp.

Kaplen has also taken his runs at me. A few years back he represented me (with significant help from another attorney behind the scenes) in a case against what was then called the NY State Crime Victims Board. On one occasion I left him a voice mail with some questions. He then left me a voice mail angrily telling me not to ask him stupid questions (this from a man whose law firm claims to act with compassion towards people with brain injuries). Then, when the judge had the case under review, I left him a message telling him that whatever the judge decided, we needed to talk to determine how best to roll out our response to the media.

Can you guess how I found out the judge ruled in our favor? A reporter called me to ask me my response to the ruling. Who told the reporter? Right. Kaplen. And so, I decided to have some fun. I left Kaplen a voice mail. In it I told him that he should be grateful that it was not 25 years earlier because had he done this back then I simply would’ve taken him outside and slapped the sh*t out of him. He later whined that I’d threatened him. No, I explained, I did not threaten you. I simply explained what would’ve happened to you 25 years ago, so, be happy; you’re a lucky man.

The world of brain injury in New York is not lucky to have Michael Kaplen in their midst. It is my hope the council will stand up to his bullying and cut him loose.  If they do, then we can all be lucky together. And then, we can all focus on the difficult challenge of supporting each and every New Yorker with a brain injury in their just quest to reach their maximum level of independence.

****

As promised:

TRAUMATIC BRAIN INJURY SERVICES COORDINATING COUNCIL

NYS Department of Health

875 Central Avenue, Albany, New York

(Main Conference Room)

Thursday, March 1, 2012

10:30 AM – 3:30 PM

AGENDA

10:30am – 10:45am Welcome

Introduction of New Member

Review and Approval of Minutes from

September 12, 2011 Meeting

10:45am – 12:00pm New York State Five Year TBI Action Plan

Carla Williams, Deputy Director, Division of Long Term Care, NYSDOH

12:00pm – 1:15pm LUNCH (Members on their own)

1:15pm – 2:00pm Impact of MRT proposals on TBI and NHTD waivers:

Medicaid Managed Care and Repatriation of individuals served out of NYS

Jason Helgerson, Deputy Commissioner, Office of Health Insurance Programs and NYSDOH Medicaid Director

2:00pm – 2:30pm Coordinated Medicaid Managed Care Program for Individuals with TBI

Joseph Vollaro, PhD.

2:30pm – 3:00pm Subcommittee reports

· Healthcare Reform/Non-Waiver Service Needs

· Public Awareness/ Injury Prevention and Information Dissemination

3:00pm – 3:30pm Public Comment/Summary/Next Steps/Adjournment