Cuomo’s Dept. of Health gets even sleazier

When the New York State Traumatic Brain Injury Services Coordinating Council was formed in the 1990s when the late Mario Cuomo was governor who could have imagined that less than 20 years later, his son and current governor, Andrew Cuomo, would do everything in his power to undermine and pulverize, not just the council’s ability to function, but the sense of safety and right-to-privacy citizens have when attending the TBISCC’s public meetings.

During a remarkably productive TBISCC meeting this Friday, this writer learned and attorney for the state’s DOH, Nicholas Cartagena (nicholas.cartagena@health.ny.gov)  issued an email to a private citizen saying  if she wanted copies of the council’s minutes she would need to file a FOIL (Freedom of Information Law) request. For the past two decades council minutes were made available to members of the public once approved by the council. They’d be available at the meetings or sent via email or regular mail.

There’s an even more ominous sign in Cartagena’s email. He says the TBISCC is part of the DOH and therefore it documents are subject to FOIL. This is the first time to this writer’s knowledge that a state official has blatantly claimed the council is part of the DOH and therefore the DOH runs the show. While this certainly appears to violate the legislation that formed the council; it unequivocally violates the purpose of the council, which, under this governor more than any other, seems to be the goal.

This is just one more example of Cuomo’s DOH doing all it can to be obstructionist, when it comes to the public’s right to know what it’s government and  advisory councils to state agencies are doing.

Not only does a FOIL requirement violate the construct of the relationship the advisory council has with the public, it puts an unnecessary and punitive burden on people with brain injury disabilities.

  • First: Submitting a FOIL request to the DOH is a laborious and time consuming process, largely because of the DOH’s at times blatant resistance and disingenuous posturing in response to the request. I recently submitted a FOIL request (after an email request to Deputy DOH Commissioner Mark Kissinger was ignored) asking who in the DOH was drafting the manual for the TBI (Traumatic Brain Injury Waiver).  After a month I was informed the DOH needed an additional month to gather the names. When the names identifying those creating the manual finally arrived, months after the FOIL was submitted, they were: Mark Kissinger, Lydia Kosinski, Maribeth (Knuckles) Gnozzio and Dawn Weiss, the latter three all directly under Kissinger. In other words, Kissinger and the DOH knew and had the requested information the moment it was asked for.
  • Second: The DOH can legally charge 25 cents a page for documents provided as a result of a FOIL request, making it a financial burden for those on fixed incomes like, say, many New Yorkers with brain injuries.

Unless one’s been living under a rock, or, is severely delusional, it seems quite clear that Andrew Cuomo is New York’s version of New Jersey’s Chris Christie. He’s a bully. Something his father was not. He also doesn’t give a damn about New Yorkers with brain injury disabilities, a group of people his father genuinely cared about.

Perhaps when no one was looking, Cuomo took a pledge not to follow in his father’s footsteps. If so, he’s living up to it. I’ll give him that.

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The heinous among us

If you know someone with a disability then you know there are people in the public and private sector who willfully make and support decisions denying equal rights to people with disabilities (PWD).  Decisions and policies that put peoples homes  and lives  at risk, deny, reduce or take away services that allow PWD to attain their maximum level of independence, send them out of state for sub-par care; in short, treat them as something less than human.

I do not understand how one human being can treat another human being like they are little more then feces and sleep at night. People who treat people like this are the misguided heinous among us and should be exposed and held accountable at every turn.

Some in the private sector see us (I live with a disability) merely as a way of making money. We are revenue streams, nothing less, and certainly nothing more. Not long ago there was a phone conference in my home state of New York among various parties involved in the state’s Traumatic Brain Injury Medicaid Waiver. The idea of allowing family members to act as home staff and get paid for doing so came up, the argument being that the presence of family, of loved ones in someone’s care, can help in the rehab process.

Some in this phone conference, including providers, thought this was a good idea. However, another provider complained that allowing family members this role would mean he would “lose hours.”  While I will not name this person, I know him. He told me once he had considered becoming a monk and, as far as I know, attends church on a regular basis.

Now, I’ve been an equal rights advocate for some time. I’ve never run across a government agency more ruthless and inhumane in its treatment of, in this case, people with brain injury disabilities, than Andrew Cuomo’s New York State Department of Health.  If actions speak louder than words, they do not care a wit about the lives of New Yorkers with brain injuries.

First of all, those in the DOH who oversee the TBI Waiver program and write the TBI Waiver Manual have absolutely no formal training or formal education in the brain. Not one iota. When I recently asked Deputy DOH Commissioner Mark Kissinger for the names of those in the DOH drafting the TBI Waiver manual, he would not tell me. Finally, a FOIL request pried the names from the DOH’s secretive claws. Who are those drafting the manual? Kissinger, Maribeth “Knuckles” Gnozzio, Lydia Kosinski, a DOH attorney and a member of the office staff. Not one of them has any formal training or education in the brain.

Along with the DOH, New York has the Traumatic Brain Injury Services Coordinating Council. Advocates for people with brain injury disabilities are waiting to see if, under its new leadership, the TBISCC will, finally, hold the DOH accountable, present real proposal to the DOH, and publicize all the council is doing online for all to see. It has been repeatedly suggested to the TBISCC that it create its own facebook page and or start its own webpage. This has not happened, yet, but if they are as sincere as we are hoping, these webpages will appear.

The TBISCC was formed by an act of the New York State Legislature in 1994 to ” to recommend long-range objectives, goals and priorities, as well as provide advice on the planning, development and coordination of a comprehensive, statewide TBI program.” One need look no further than the council’s minutes to confirm the DOH’s lack of interest in doing anything to respect and grow the lives of NYers with brain injuries. Consider this. Not once, in 20 years, has the DOH asked the council for input on how best to serve New Yorkers with live with brain injuries.

Some time ago a friend of mine was cautioned about me by a now retired individual who was in the field of brain injury: “Be careful he doesn’t turn on you,” she warned.  This individual knew at the time that I don’t “turn on” people. She also knew at the time that I will expose people or groups, private or public, who are denying people their rights, treating people as if they are less than human. Such was the case with this person. She was once part of a committee drafting a proposal on behalf of people with brain injuries when other committee members pointed out there needed to be people with brain injuries on the committee. She said this was not true. There was no need for people with brain injuries, after all, she explained, she spoke for them.

Rubbish.

The heinous among us. The greatest justice we can do ourselves and them, is to bring their behavior into the light, expose them. Whatever discomfort this might cause them is nothing compared to the torment and suffering their putting PWD through, and making a living doing it.

Cuomo’s DOH: secretive, cruel, dishonest & incompetent

Whether or not you’re on the New York State’s Traumatic Brain Injury Medicaid Waiver, you’ve got no allies in Governor Andrew Cuomo’s Department of Health. In fact, Cuomo’s DOH is the main reason NYers with brain injury disabilities are struggling to get the services they deserve.

Recently this writer asked Deputy DOH Commissioner Mark Kissinger who in the DOH was drafting the new TBI Waiver Manual. He would not tell me. Never mind that he oversees the waiver and knew the answer, he simply would not tell me. I then filed a FOIL (Freedom of Information Law) request for the information. After about twenty days I received notice via email that the DOH needed another 30 days to gather the information.

In other words, I was being asked to believe that Kissinger genuinely needed 50 days in all to figure out who worked for him. 

In all likelihood the reason for the DOH’s reluctance to provide the information is linked to the following fact. Not one of the people drafting the manual have any expertise at all in the brain. Not a clinician among them. In fact, when the information requested  finally arrived, those drafting the manual are some of the DOH folks who’ve been inflicting the most damage on waiver recipients, cutting services whenever they can think of an excuse, ending housing subsidies, limiting services, and sending out notices seeking to throw people off the waiver altogether.

Who are those in the DOH drafting the manual (an in-progress document the DOH will not share with anyone)? Kissinger, Lydia Kosinski, Dawn Wiese and, Maribeth “Knuckles” Gnozzio. Gnozzio stopped attending meetings of the state’s Traumatic Brain Injury Services Coordinating Council (TBISCC) once her rather problematic background was fully exposed in this blog. Never mind that she’s the program director for the waiver, why bother to attend council meetings when the council’s legislative mandate is to help the DOH identify effective ways of growing the lives of NYers with brain injuries?

The DOH’s dishonesty is on display anytime it professes to care about NYers with brain injuries.

It warehouses some with brain injuries in other states, and despite spending millions of NY taxpayer dollars for their care, refuses to follow-up when informed a NYer placed out of state is suffering or, worse still, being neglected, abused. At a recent TBISCC meeting DOH officials were anything but response when asked what, if anything, prevents New York from filing a complaint with the federal government’s Centers for  Medicaid & Medicare Services (CMS) if it suspects a NYer placed out of state is not getting proper care. CMS oversees long term care in all the states. The fact is, the DOH doesn’t care. Despite the huge sums for keeping NYers placed out of state, sources say it is less expensive than bringing them home.

Lest anyone think there is an upside to the DOH, consider this.  A federal judge had to issue a restraining order in 2011 to prevent the DOH from throwing from throwing a 66-year-old disabled woman off the the TBI Waiver and ending her housing subsidy and demanding the woman pay them $24,000, all without explanation. Actions that would have likely put her life in danger by rendering her homeless.

Can you guess who in the DOH were driving the bus back  in 2011? Let me help you: Kissinger, Kosinski, and “Knuckles” Gnozzio. Three of those drafting the TBI Waiver manual. No wonder they didn’t want anyone to know.

NY State’s assault on NYers with brain injuries continues unchecked

The New York State Department of Health is refusing to release the names of the people  drafting the new manual for the state’s Traumatic Brain Injury Waiver.  To his credit, Deputy DOH Commissioner Mark Kissinger has revealed the state’s  opinion of New Yorkers with brain injuries, particularly those participating in the TBI Waiver. He ignores them. He now ignores written requests for the names of those DOH staff (and contract employees, if any, are involved) designing the TBI Waiver Manual. Moreover, the DOH, thus far,  has not honored a Freedom of Information Law request for the names filed by this writer.

The TBI Waiver is a Medicaid program designed to keep those with brain injury disabilities living in the community and to help others return to the community. Kissinger, who has more than once and no doubt will again profess DOH’s desire to work with all stakeholders – has proven that assertion to be glaringly disingenuous. It’s too bad because the likes of the Brain Injury Association of NY State, the state’s Traumatic Brain Injury Services Coordinating Council, Disability Rights New York (the state’s protection and advocacy agency),  the Kahrmann Advocacy Coalition, along with people with brain injury disabilities, their  families a friends, experts in the field of neurology, and more,  are all willing and eager to work collaboratively with the DOH. The DOH is not interested in collaborating with anyone.

Disrespecting New Yorkers  with brain injury disabilities is nothing new for the DOH. Things have gotten even worse under Governor Andrew Cuomo. Several, who have asked not to be named out of fear of reprisal from the governor, have said Cuomo is something of a bully. I’m not surprised. It would be nice to learn otherwise, but actions speak louder than words and given that Cuomo has a well-earned and even admirable reputation for keeping close tabs on all state agencies, it is impossible to believe he is unaware of the DOH’s disrespectful and ruthless treatment of NYers with brain injury disabilities, not to mention the similar treatment the state inflicts on those waiver providers struggling to provide the best services for their clients. There has not been an increase in reimbursement rates for them since 2007 and providers receive zero reimbursement for training their staff in brain injury.

All this brings us back to the DOH’s refusal to release the names of those designing the TBI Manual. I suspect one of the underpinnings for the refusal is this: those developing the manual have no expertise whatever in the brain or brain injury. A sickening and scary truth.

Please don’t think this is the only example of the DOH savaging the rights of New Yorkers with brain injuries.  Until November 2011,  if you filed a complaint related to the TBI Waiver you were never ever informed of the outcome of the complaint. If you were a waiver participant and your rights were denied in some way or you’d been abused or had your belongings stolen by a staff member and you filed a complaint with the DOH, you were never told the outcome of the complaint. The DOH acknowledges this. And, when it claimed to have changed this policy, agreeing to inform participants of the outcomes of their complaints, one DOH official admitted  the DOH was unable to provide the outcomes for the thousands of complaints previously filed. Given the waiver came to New York in 1995 were talking about complaints filed over a span of 16 years whose outcomes will never be provided to the complainants. Interestingly,  the DOH official who openly admitted the DOH was unable to provide the outcomes to these complaints was none other than Deputy Commissioner Mark Kissinger, the very same DOH official who now ignores requests for information New Yorkers legally have a right to.

You wonder if the likes of Kissinger and Cuomo forget they work for New Yorkers. Perhaps they simply don’t care.

New York’s Cuomo shaky on ethics reform

How New York Governor Andrew Cuomo can talk about the need for ethics reform while heading up a secretive, dysfunctional, and, at times, ruthless state department of health s beyond me. But, then again, self-serving lip service from a politician is nothing new, and nothing to praise.

This blog has for years now documented the problems with the state’s DOH, particularly its approach to New Yorkers with brain injury disabilities (BID). The state’s Traumatic Brain Injury (TBI) Waiver, a form of Medicaid reimbursement designed to provide services to people with BID so they can remain and or return to the community is headed up by Maribeth Gnozzio, whose sole claim to fame was not being prosecuted by the federal government as part of an arrangement between her husband, Robert Janisewksi, former Hudson County executive in New Jersey, who was prosecuted for taking bribes and sentenced to 42 months in federal prison, and the FBI. 

Knuckles Gnozzio, as I like to call her (we met once at a meeting and when shaking hands at the end of the meeting I discovered Knuckles is one of those folks who for some odd reason thinks its impressive (or scary?) to squeeze someone’s hand as tightly as possible in a handshake) issued a verbal directive in October 2010 blocking TBI Waiver Providers from advocating for waiver participants at Medicaid Fair Hearings. These fair hearings are designed to allow Medicaid recipients to contest decisions to cut or end services altogether, a task not easy to accomplish when your BID makes speech, memory, hearing, noise management, etc. a challenge. Something the DOH knows perfectly well.  Nothing depicts the lack of commitment to PWBID more clearly than the fact the DOH does not require staff involved in overseeing the TBI Waiver to have any training in the brain whatsoever.

In some (not all) respects, the DOH’s handling of the waiver has been highly unethical from the start. For example, from 1995 until recently, waiver participants who filed complaints with the DOH related to the waiver were never told the outcome of their complaints.  Can you imagine filing a complaint with a law enforcement or regulatory agency, company or school and never being informed of the outcome? 

Equally troubling was the fact the Brain Injury Association of New York State (BIANYS) remained dead silent on the fair hearings and complaint issues  and the state’s Traumatic Brain Injury Services Coordinating Council (TBISCC) did nothing about either. Until recently, the TBISCC was simply a forum for its leaders to grandstand and its contingent of truly committed members to be stifled.

It was almost beyond comprehension to discover in late 2012 that council chair at the time, Michael Kaplen (former BIANYS president) and council vice-chair, Judith Avner, (current executive director of BIANYS) were still at the head of the table even though their terms had expired nine years and eight years earlier – Avner’s on Aug. 9, 2003 and Kaplen’s on Feb. 12, 2004. Kaplen is no longer chair and Avner is no longer vice-chair. Some thought their true colors emerged at the last council meeting when, no longer being at the head of the table, both left the meeting during the lunch break and never returned. The council has a new chair and BIANYS has a new president so this pen is somewhat hopeful things will change. But, as the saying goes, actions speak louder than words.

As if all this weren’t enough to make one question the sincerity of Cuomo’s commitment to ethics reform, consider this. Last year New York State spent something in the neighborhood of $133 million in New York dollars for the care of New Yorkers placed in out-of-state medical settings. However, if you are a family member who is concerned about the care your family member out of state is getting, you will get no help or support from the DOH. They will tell you they do not have jurisdiction over out-of-state facilities (which everyone knows). What they don’t tell you is that until a few years ago, the DOH did have staff who would follow up on the concerns of family members, request and get case notes, set-up meetings between concerned family members and the respective facilities, and help resolve the issues at hand. Not anymore. So, again, the governor can talk about the very real need for ethics reform all he wants, but somebody better tell him, actions speak louder than words.