In Praise of Bill Combes

When you live with a disability, in my case a brain injury, you encounter those whose commitment to your rights is rooted in self-serving lip service and then you encounter those whose integrity, compassion and commitment to people with disabilities is so real and genuine they glow. In the case of Bill Combes, I suspect this good and decent man can read by his own light.

Bill Combes worked out of the New York State Commission on Quality of Care (CQC) for something in the neighborhood of 30 years and as of Wednesday this week, has entered into well-deserved retirement. If ever there was one deserving of accolades from the White House to the State house to the house on Main Street, it is Bill Combes.  The CQC is the Protection and Advocacy agency contracted with the federal government for brain-injured New Yorkers like me. The only flaw in the CQC is, like all such agencies, they never have the number of staff they want, and, frankly, deserve.

Disability rights advocates like me always knew they would get a serious attentive audience when talking with Bill. We also knew that Bill and the CQC would do all it could to fight for the rights of brain-injured New Yorkers. Unlike the state’s Brain Injury Association and Traumatic Brain Injury Services Coordinating Council and, for that matter, the Department of Health, Bill Combes and the CQC always offered more than just lip service.

Those of us with disabilities have lost a wonderful ally now that Bill has retired. But, wherever he is, I hope he knows that all the lives he touched are better off because of him. Unlike too many others, he never experienced or treated anyone with any disability as being less than. The completeness of each person’s humanity and worth was never – and I mean never – lost on him.

I am blessed to know him and have had the privilege of working with him. Now it is his family’s turn to have the all of him, and this includes his first grandchild, a granddaughter; she’s in for quite a treat.

Justice 1 NYS DOH 0

It took the combined efforts of the NYS Commission on Quality of Care, an RRDC (Regional Resource Development Center) with real principles, the Kahrmann Advocacy Coalition, and the threat of legal action to get the NYS Department of Health to drop its efforts to block this writer’s request for three-white noise machines needed to manage marked noise sensitivity secondary to my brain injury.

A complete recount of my efforts to get the white-noise machines and the DOH’s determination to prevent me from doing so can be read in a preceding blog post. Suffice it to say that a ruling resulting from a December 1, 2010 Medicaid Fair Hearing overturned the DOH’s denial of my white-noise machine request, telling them that they needed to consider more evidence documenting the need for the machines.

More evidence was provided and the Southern Tier Independence Center, the RRDC in my area,  sought to approve the request before the DOH’s Maribeth Gnozzio stepped in and blocked the approval. How do you spell retaliation? Try G-n-o-z-z-i-o. However, were Gnozzio the exception to the rule at DOH she’d be long gone, but she’s not, which tells us she is an example of what the rule is at the DOH, and those DOH employees who do care, are in the minority.

Once Gnozzio blocked the white-noise machine request a request for an expedited Medicaid Fair Hearing went into effect. Once that happened, and once, I am sure, Gnozzio and the DOH realized their actions would accurately be seen as retaliation, a knowing attempt to harm me, and a flat-out violation of the ADA, they backed off. Gnozzio and the DOH also realized they were dealing with an RRDC who truly does care and was not about to back off its principles for anyone.

If the DOH wants to reveal that Gnozzio is an exception to the DOH mindset or signal that it is committed to changing it’s mindset, I’ve got a two-word suggestion that would go a long way on both fronts: fire Gnozzio.

NY State DOH Snubs Brain Injury Summit

Despite agreeing to continue attending the brain injury summits, the New York State Department of Health today was a no-show. The snub was  a blatant act of disrespect for the groups who did attend the second Brain Injury Summit: The Brain Injury Association of New York State, the New York State Commission on Quality of Care and Advocacy for Persons with Disabilities, the Providers Alliance and the Kahrmann Advocacy Coalition. Moreover,  it further underscored the ongoing problem of poor communication on the part of DOH, a problem DOH Deputy Commissioner Mark Kissinger acknowledged the DOH has at the first summit this past September.

The snub served to further enhance the view that the DOH has very little respect for brain injury survivors. The DOH didn’t even have the decency tell people they weren’t coming. Keep in mind, this is the lot that gave the “keys” back to PhD-Wannabe Timmy Feeney.

The summit attendees did very much agree on a response. Given the response was a group design, it would be inappropriate for me to elaborate, other than to say the response is rooted in a genuine care and concern and commitment to assure that brain injury survivors and providers are given the kind of support and clarity they deserve.

I can also tell you that all in attendance were heartfelt and genuine in their commitment to help brain injury survivors grow their independence and, it must also be said, that all in attendance, this writer included, continued to express a willingness to work with the DOH.

However, if you’ll allow me a shot at pointing out the obvious, it is hard to work with anyone who doesn’t bother to show.

The third summit is scheduled for February 11, 2011.

Brain Injury Summit II This Friday

The second Brain Injury Summit will be held Friday morning in Albany.  Those invited included the Brain Injury Association of NY State, the New York State Department of Health, the New York State Commission on Quality of Care, the Providers Alliance, the Brain Injury Coalition of Central NY, and the Kahrmann Advocacy Coalition.

Given that effective and fluid communication between all is a challenge not uncommon in any multifaceted system, communication will be the primary focus.

The DOH of late has taken a great deal of heat, both from this “pen” and from others. It is my sincere hope that some of the challenges now being faced by survivors, providers, advocacy groups and, not incidentally, the DOH are clarified so when all parties leave the summit, heads are in a more serene place, there is greater clarity all around,  and the commitment to open and effective communication is, in some instances renewed and in other instances begun.

All parties actively took part in the first summit and I fully expect the same this time. There are some justifiably frightened survivors across the state and some understandably worried providers. To say lives are at risk is anything but an understatement.


NY State Department of Health Blocks Medical Treatment

Whether you are intentionally blocking medical treatment or you are doing so because you are incompetent, it is cruel and inhuman treatment, particularly when the treatment is prescribed by the doctor and wanted by the patient.   When it’s the New York State Department of Health blocking the treatment,  heads ought to roll.

As I mentioned in an earlier blog post, “Those close to me are beginning to think, with some justification it seems, that the New York State Department of Health is not only purposely dragging it’s feet signing off on a life alert and some assistive technology its own RRDC has approved for me, but is, in fact, preparing to boot me off the state’s traumatic brain injury waiver.”  I went on to say that the jury was still out for me but after a careful review of emails ranging from February 2010 to October 23, 2010,  it is clear the concerns of those close to me are on target. The DOH behavior is either intentional or it is incompetence.

If it is the latter, as many think, it means there are people with brain injuries in this state who are enduring the same kind of neglect I am.

A Review, an Anecdote, and the Timeline


My brain injury was sustained in 1984 when I was held up and shot in the head at point blank range. The bullet remains lodged in the frontal lobe of my brain with bone spray throughout the left frontal and temporal lobes. One of the things I’ve learned over the years both from living with the damage and from working in the field of brain injury for more than 15 years is this; the role the injury plays in one’s life changes over time. For the past six years or more I am unable to work a full time schedule of any kind, fatigue has become that much of a factor. Moreover, my sound sensitivity has become very pronounced over the years, so much so that I will often use a fan or an old white noise machine so I can sleep, read, write, at times concentrate on a conversation.

In addition to this, my health has changed. I have a heart condition called a blocked left bundle branch. The left and right bundle branches are your heart’s pacemaker. When one becomes blocked, it is not always clear why, it never becomes unblocked. Research says a blocked left bundle branch is potentially the more problematic of the two. In addition, I deal with asthma, PTSD, and an on again off again fight with depression.

At any rate, all of the previous realities, along with the fact I live alone in a rural area, led me, along with my case manager, doctor, therapist and loved ones to conclude I would be wise to bring two forms of assistive technology into my life: three white noise machines so they can be kept in various areas of the house so my quality of life and ability to comfortably function would improve and, of critical importance, a life alert, so in the event of a medical emergency I can get assistance with the mere push of a button.


Several years ago I was meeting with a group of brain injury survivors, there was about 20 of us. One of those in the group, a friend of mine I’ll call Terrence, had, like me, sustained his injury from a gunshot wound to the head. Terrence and I were facing each other, each sitting at one end of two adjoining tables. Someone raised the question of what we would do if anyone ever pulled a gun on us again, threatened our lives again. Terrence was and is a cheerful animated human being with a beautiful heart and soul, but now his face darkened. So did mine. Terrence said, “Next time someone threatens my life they better not miss  ‘cause I’m gonna try’n kill’m. I’m sick of it.”  We were heart and soul joined in this. Our eyes were joined as I said, “Me too.” In both of us, and those like us, there is a bone chilling electrified intimacy when someone tries to kill you, threatens your life.

There is a heartless cruelty found in the minds of those who knowingly put the lives of others at risk. And, I can tell you, some of what joined me and Terrence in that moment churns through my veins now as I experience a Department of Health that is knowingly putting me – and no doubt others – at risk.

The Timeline

See Information Key Below for Further information

  • Discussion of sound machines/life alert surfaces in emails, in Feb. 2010
  • Feb. 26 email referencing voice mail from Sue Williams, from CFDS saying they will help me get sound machines.
  • April 9 email to Jessica Pakatar from William Buse (my therapist) documenting need for sound machines and life alert.
  • April 12 email documenting first unpleasant conversation with Natalie Marabello in which she said Jessica Pakatar should reach out to Rob Korotich to make sure therapist email enough. Note: Marabello does not inform us a letter from an MD will be needed for life alert and white noise machines.
  • May 21 email documents conversation that day with Sue Williams in which she said Jessica Pakatar could work with someone in CFDS business office to order to obtain sound machines.
  • Circa late May we are told by RRDC office that all necessary documentation was in for white noise machines and life alert approval.
  • Two months later on August 12 email documents phone call with Rob Korotich who says Jeanette Biggs of DOH now says MD letter is needed for sound machines and life alert. This is Four months after April 12 conversation with Marabello.
  • August 12: approx date I filed a complaint with DOH via BIANYS complaint line re: Marabello’s earlier behavior on the phone and poor handling of assistive technology request.
  • August 12 email from me filing complaint directly to DOH complaining about handling of Assist. Tech request sent to: Mark Kissinger, Mary Ann Anglin, Cavallo, Jessica Pakatar – No response from DOH
  • August 18: Marabello calls to investigate assist. tech. complaint, announces she is aware I have active complaint against her but says she cannot investigate that complaint. I hang up on her when she appears to imply I am feigning need for white noise machines and life alert. I send out an email same day to: Mark Kissinger, Mary Ann Anglin, Maribeth J Gnozzio, Bill Combes, Sim Goldman, Marie Cavallo, Beth Cassidy, Jessica Pakatar, Maria Relyea, KAC Leadership Team notifying them of her behavior. – no response from DOH
  • Circa August 19 file separate complaint with Sunnyview Hospital, Marabello’s employers re: her behavior.
  • August 26, extensive telephone Interview with DOH’s Jan Koenig  re: Marabello complaint and assist tech. complaint.
  • Letter sent same day as above via email to Jan Koenig at her request documenting complaint interview
  • Sept. 7 letter from my Primary Physician documenting need for life alert & white noise machines sent to SC & DOH (RRDC)
  • Sept. 14, Jessica and I meet w/Marie Relyea and Wendy Tracy re: Marabello complaint filed with Sunnyview.
  • Sept. 28 email sent to Jan Koenig expressing concern that I have heard nothing about Marabello complaint – no response from DOH
  • Sept. 28 send letter to NE Health CEO Dr. James Reed seeking status of complaint filed against Marabello via Sunnyview
  • Sept. 29 letter mailed to NE Health CEO Dr. James Reed re: Marabello
  • Oct 4 RRDC signs off on assist tech and life alert and forwards to DOH for signature
  • Oct 6 email to Gnozzio asking about HEAP and food stamp contacts in county I am moving to – no response from DOH.
  • Receive Oct. 6 letter from Sunnyview CEO Edward J. Eisenman presenting their complaint findings. Send thank you letter the following day.
  • Oct. 6 email sent to Beth Gnozzio copying Mary Ann Anglin, Lydia Kosinski and Jessica Pakatar again inquiring about hold-up on sign off on assist tech – no response from DOH
  • October 7 email to Jan Koenig copying Mary Ann Anglin and Mark Kissinger inquiring about complaint status – no response from DOH
  • October 12 email to Beth Gnozzio copying Lydia Kosinski and Mary Ann Anglin again seeking status of assist tech request – no response from DOH
  • Oct 13 email from Beth Gnozzio saying she has made recommendations and under internal review; does not address assist tech.
  • Oct 13 email to Beth Gnozzio asking when  assist. tech will be signed off on – no response from DOH
  • Oct 14 email to Beth Gnozzio inquiring about sign off – no response from DOH
  • Oct 17 email to Beth Gnozzio inquiring about sign off – no response from DOH
  • Oct 19 Mary Ann Anglin resends Beth Gnozzio’s Oct 13 email referenced above
  • Oct. 21 email to Beth Gnozzio copying Mary Ann Anglin and KAC Leadership Team inquiring about sign off for assist. tech. et al – no response from DOH
  • Oct 22 email to Beth Gnozzio copying Mark Kissinger, Mary Ann Anglin, Lydia Kosinski, Carla Williams, Bill Combes, Sim Goldman, Marie Cavallo and KAC Leadership Team – letting them know another complaint now filed via BIANYS – no response from DOH

Information Key:

BIANYS: Brain Injury Association of NY State

CFDS: Center for Disability Services, Albany, NY

RRDC: Regional Resource Development Center: Agency under contract with DOH to oversee waiver providers and services in a region of the state

Mary Ann Anglin: DOH Director, Division of Home & Community Based Care Services

William Buse, LCSW, PhD: Therapist

Jeanette Biggs: DOH employee.

Marie Cavallo: President of BIANYS

Bill Combes: NY State Commission on Quality of Care

Edward J. Eisenman: CEO of Sunnyview Rehabilitation Hospital

Sim Goldman: Senior Attorney for Disability Rights Advocates, Albany NY.

Lydia Kosinski: DOH Assistant Director, Divison of Home & Community Based Services

Natalie Marabello: RRDS (Regional Development Specialist) working for Capitol Region’s RRDC

KAC Leadership Team: Leadership committee for Kahrmann Advocacy Coalition

Mark Kissinger: Deputy Commissioner, NY State DOH

Jan Koenig: Member of the DOH employee assigned to investigate assistive tech. complaint and complaint against Ms. Marabello

Rob Korotich: RRDS in the Capitol Region

Jessica Pakatar: My case manager/service coordinator through Catholic Charities Disabilities Services, Albany, NY

Dr. James Reed: CEO of Northeast Health

Marie Relyea: RRDS Capitol Region

Wendy Tracy: RRDS Capitol Region

Carla Williams: DOH Deputy Director Office of Long Term Care

Sue Williams: Director of Service Coordination for CFDS


The Key’s content clearly documents the number of people aware of the DOH’s behavior. Nevertheless, the DOH does not sign off on my assistive technology request which has been deemed a medical necessity by my doctor and therapist and approved by their own RRDC. As a result, no white noise machines and no life alert which, in short, damages the quality of my life and puts me at risk. What is even more unsettling is this; if their treatment of me is not aimed at me personally, that means there are many men and women around the state absorbing the same neglect and thus being placed at risk.