Cuomo’s dysfunctional Department of Health remains unchecked

An attorney for New York State’s records access office says the state’s Department of Health does not maintain records identifying how many New York State Medicaid recipients with brain injuries are placed out of state. A shocking admission given the DOH has spent roughly 1.5 billion of the state’s Medicaid dollars on New Yorkers placed out of state from 2003 to 2013.

In a March 21 letter responding to a FOIL (Freedom of Information ) request filed by this writer asking, in part, how many New York State Medicaid recipients with brain injury disabilities are currently placed out of state, Elizabeth Sullivan, an attorney for the state’s records access office,  says “the department [of health] does not maintain Medicaid data for those diagnosed with (brain injuries) as no such coding exists exclusively for these diagnoses.”

Just when you think it impossible for the state’s DOH to appear even more dysfunctional – and disingenuous – the DOH proves you wrong. There is ample evidence of disingenuousness when it comes to the DOH. One example would be a sentence in Ms. Sullivan’s letter to me: “Upon further review of your conversations with Mr. (John) Harper (of the state’s Office of Health Insurance Programs) this office has determined the following enclosed tables are responsive to your request.”  Kudos to Ms. Sullivan for a well-written sentence. One minor problem with its content; I never had conversations with Mr. Harper. As for the tables she references. They list the numbers of New York residents on Medicaid placed out of state but whether they have brain injuries or not is anyone’s guess.

Another example of the DOH’s disingenuousness is its public assertion that it cares about New Yorkers who live with brain injuries yet when those who are stakeholders seek to work with the DOH to improve the lives of NYers with BID, the DOH gives them the straight arm. The DOH recently took part in a phone conference with representatives from  the Brain Injury Association of NY State, the Center for Disability Rights, Disability Rights NY (the state’s protection and advocacy agency), the Traumatic Brain Injury Services Coordination Council (TBISCC) and the state’s Justice Center. It didn’t matter that the DOH had the agenda for a week, nor did it matter the agenda asked the DOH to clearly identify the number  of New Yorkers with BID placed out of state, and, clearly identify what support family members of those placed out of state could count on from the DOH. DOH representatives on the call provided none of the information sought. The DOH would not commit to a follow-up meeting with the stakeholders.

There is an effort underway to create an independent office for brain injury in the state. Good idea. But the current effort asks that the office remain in the control of the DOH. The very notion of the office being under the control of the DOH is a betrayal of New Yorkers with BID and their families. In truth, the office would be well-situated in a non-state agency, a non-profit that knows the plight of those who live with disabilities: CDR (Center for Disability Rights) would, at this point, be this writer’s choice. In fact, if the Cuomo administration wants to prove their claim of caring about individuals with BID is more than lip service (as well as his voiced commitment to ethics reform), then it should recognize that both the TBI and Nursing Home waivers  would be well-served under CDR’s leadership.

Over the past few years this blog has more than once memorialized the truly sickening mess that is the DOH. Examples abound: for 15 years plus  if you were a participant in the state’s Traumatic Brain Injury (TBI) Waiver and filed a complaint, the DOH never informed you of the results of your complaint. For 15 years the DOH’s most powerful person, when it came to the TBI Waiver, was Timothy J. Feeney, who then and now misrepresented his educational credentials, telling all the world he had a PhD and a Masters Degree when, in truth, both documents were issued by a now defunct diploma mill off the coast of Australia and were not and are not recognized as valid anywhere on planet earth.

Then, of course, you have the saga of Maribeth “Knuckles” Gnozzio. Knuckles, who wields enormous power on both the TBI Waiver and the Nursing Home and Transitions Waiver fronts, appears to have escaped federal prosecution thanks to a deal cut by her husband, Robert Janiszewski, who was convicted in 2002 of extortion and tax evasion by federal prosecutors. As this blog pointed out in January, Cuomo’s stated commitment to ethics reform is nothing more than smoke and mirrors if Gnozzio remains in place.  Reform “doesn’t seem to be on Knuckles Gnozzio’s mind. In 2010 she was the one who issued the verbal directive blocking waiver staff from advocating for waiver participants at Medicaid Fair Hearings, a move that has undermined the ability of many to truly represent themselves, which was Knuckles plan? Was it Cuomo’s plan as well? Or did he simply not know what his DOH was doing. He has known for some time now, and still not change. It was also Knuckles Gnozzio that directed that the housing subsidy this writer was receiving when he was on the TBI Waiver be taken away and it was Knuckle’s Gnozzio who led the effort to deny this writer a request for white noise machines secondary to sound sensitivity related to my brain injury. Gnozzio needs to go and, if Cuomo is telling the truth about his commitment to ethics reform, she will. If he isn’t, she won’t.”

It seems to me that the best thing that could happen for New Yorkers, in and out of state, who live with BID, is for the DOH to be removed from the equation altogether.


Pivotal Meeting for NY State’s Brain Injury Council

So far the New York State Traumatic Brain Injury Services Coordinating Council (TBISCC) has done anything but live up to its legislative mandate: offer proposals and ideas and guidance to the state’s Department of Health, a state agency that ought to be the national role model for resisting any and all input from anyone other than itself, to improve the lives of New Yorkers with brain injury disabilities. Thus far the TBISCC and the DOH is a marriage made in some kind of bizarre, dysfunctional, self-absorbed heaven.

The council meets May 31 and if the agenda (provided below) is any indication, the first portion of the meeting will provide members of the public a close-up view of two of the primary impediments to  equal rights for New Yorkers with brain injury disabilities:  Michael Kaplen and Judith Avner. Kaplen has proven in more than one venue that he is little more than a bully and Avner, the executive director of the Brain Injury Association of NY State sank to a new low last year when she blocked people with brain injury disabilities from being on a committee formed to – wait for it – represent people with brain injury disabilities.

One wonders what Avner’s presentation on “behalf of BIANYS” will include. BIANYS staff members past and present have said disagreeing with Avner on any front results in a nasty backlash; it is made clear that Judy is not to be questioned. At any rate, given that BIANYS has remained dead silent in the face of the DOH’s behavior (one example being a DOH directive that TBI Waiver Providers cannot advocate for their clients at Medicaid Fair Hearings, a move that viciously undercuts the chances that the client living with a brain injury disability will prevail) I imagine Avner’s presentation of, well, Avner, will be a dazzling display of charm-filled lip service.

Lest you think I am overstated the problems named Avner and Kaplen, one must remember that until recently, both continued to claim leadership of the council, Kaplen as chair, Avner as vice-chair, even though  Kaplen’s term had expired in 2004, Avner’s in 2003.

The DOH has allies in Kaplen and Avner. Neither will allow the TBISCC or the BIANYS to hold the DOH responsible for the suffering it is inflicting on New Yorkers with brain injury disabilities. Allowing the likes of Maribeth Gnozzio to head up the state’s TBI Waiver makes it clear the DOH doesn’t care a whit about people with brain injury disabilities. It is only by, one would assume, the grace of God (and her husband’s agreement with the FBI) that Gnozzio did not face criminal charges back when her husband, Robert C. Janiszewski, a former County Executive of Hudson County, New Jersey, pled guilty in 2002 to taking more than $100,000 in bribes. In a 2003 interview, the late Paul Byrne, a childhood friend of Janiszewski’s who was indicted for collecting thousands of dollars in bribes for Janiszewski,  said Janiszewski gave him up to spare Gnozzio from prosecution.

The one ray of hope for those who would like to see the council get its ethical head  above water will occur after lunch when the council will decide whether Barry Dain or Kaplen will be the next council chair. If Dain is elected, there may be real hope for the council. If Kaplen is elected, members of the council will have shown their real colors, colors that put them in lockstep with the likes of Kaplen, Avner, Gnozzio, and others.

If Dain is elected, then, perhaps, the council will reject the DOH’s proposed changes in the council’s bylaws. Examination of the  proposed changes to the by-laws  reveals a blatant DOH attempt to weaken a council, already in disarray, put the council under the state’s control, and weaken the current requirement that people with brain injuries and their families be fairly represented on the council.

I can tell you that this upcoming meeting will be closely watched. If, in fact, Kaplen is re-elected and the council adopts the DOH changes to the bylaws, direct action will be required and will be forthcoming.




Empire State Plaza, Concourse Level

Meeting Room 125

Friday, May 31, 2013

10:30 AM – 3:30 PM


10:30 – 10:45 Welcome

Welcome new member Megan Clothier

Review and Approval of 1/23/13 Meetings Minutes

10:45- 11:15 Review of Brain Injury Association of New York State TBI Recommendations

Judith Avner, Executive Director, BIANYS

11:15 – 12:00 State Agency Updates

NYSED Gerri Malone

OPWDD Nicole Suto/Nina Baumbach

OMH Debby Zeterstrom

CQC Colleen Scott

OASAS Cher Montayne

OVS Ann Marie Calabrese

DFS Jeff Pohl

DOH Lydia Kosinski/Helen Hines/Kitty Gelberg

12:00 – 12:45 LUNCH (Members on their own)

12:45 – 1:15 Election of Chair

Nominees: Michael Kaplen and Barry Dain

1:15 – 2:30 Discussion of role and mission of TBISCC/

Discussion of Bylaw Revisions

2:30 – 3:00 Public Comment

3:00 – 3:30 Summary/Next Meeting Dates/Adjournment

NY State’s Department of Health: Still the dysfunctional renegade

Some change, some don’t. Apparently the New York State Department of Health  wants to keep its membership in the latter category.

In April 2011 I wrote about the New York State Department of Health’s penchant for being a renegade agency: non-responsive, at times, outright hostile, evasive, petty and resistant to virtually any outside input. I would like nothing more than to tell you things have changed, that the DOH has come to realize it is there to serve the people of New York and, in serving them, not just be responsive to their needs, queries and input,but to treat them with respect in the process. The DOH would be well advised to take a page from it’s, by comparison,  very responsive sister agency, the Office for People with Developmental Disabilities. Of course, doing so would require being receptive to outside input, sister agency or no sister agency. One would like to think that’s not asking too much. However, with the DOH, it apparently is.

As many of you know, I am the founder of the Kahrmann Advocacy Coalition (KAC), a loosely knit but intensely dedicated grassroots group whose primary focus (thus far) has been on the challenges faced by New Yorkers with brain injury disabilities. KAC recently submitted a report to Governor Andrew Cuomo’s people as input to the state’s in-development Olmstead Plan.  Every state must have an Olmstead Plan as a result of  the June 22, 1999  U.S. Supreme Court’s Olmstead decision which, as the U.S. Department of Justice Website states: the “unjustified segregation of persons with disabilities constitutes discrimination in violation of title II of the Americans with Disabilities Act. The Court held that public entities must provide community-based services to persons with disabilities when (1) such services are appropriate; (2) the affected persons do not oppose community-based treatment; and (3) community-based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs of others who are receiving disability services from the entity.” In other words, people with disabilities have a right to live in the community. In other words, people with disabilities have equal rights. KAC’s report, among other things, identified the state’s DOH as the primary obstacle to New Yorkers with brain injury disabilities ability to gaining and keeping their equal rights, which, includes, living in the community.

Apparently, the DOH is hell-bent on underscoring the accuracy of the KAC report. If so, it is doing a fine job.

Case in point. For some time now we’ve been trying to get answers from the DOH to the following questions. One of these questions originated with a family member of an individual with a brain injury disability currently placed in an out-of-state facility. Up until a few years ago if this persons family contacted the DOH regarding the the out-of-state New Yorker (whose care, it is important to note, is being paid for by New York taxpayer dollars), a DOH employee would follow-up in an effort to resolve any issues. That does not happen anymore. As it appears now, at this writing, New York State does not monitor the care of New Yorkers placed out of state whose care is being paid for by New York taxpayers. Now, here are the questions that have been repeatedly posed to the DOH :

1) Does the DOH monitor the care of New Yorkers placed out of state in any way? If yes, how, specifically, does it do this? If no, why not?

2) How many NYers are currently placed in out-of-state facilities whose care is being paid for by NY dollars?

3) How much money does NY spend annually on NYers placed in out of state facilities?

4) What, specifically, is the DOH policy when it comes to TBI Waiver Providers advocating for waiver participants at Medicaid Fair Hearings? (Note to reader: DOH employee Maribeth Gnozzio issued a directive in a 2010 conference call to agencies overseeing the state’s  Traumatic Brain Injury Waiver on behalf of the DOH, directing that waiver providers are not permitted to advocate for waiver participants at Medicaid Fair Hearings,  a barbaric directive that undercuts the ability of many to prevail at these hearings, something the DOH knows perfectly well. While it is unlikely the idea to issue this rather sadistic directive came from Gnozzio herself, given her somewhat problematic history down New Jersey way, as described in an earlier blog piece, and her nearly universal refusal to respond to anyone, anywhere, any time, the fact her “footprints” are on the directive comes as no surprise.)

5) Please identify the person or persons in the DOH who are responsible for providing members of the public answers in their particular area of expertise and please provide their emails and direct phone lines.

None of these questions have been answered. In fact, seeking answers has led to encounters with a new director of public affairs, Bill Schwarz, who seems to be a genuinely nice person with all the best of intentions, but who has yet to produce clear answers to any of the questions (I suspect he is not the one holding up the train, as it were). It’s also led to a non-encounter with a thus far unimpressive Keith Servis, the state’s director of Office of Professional Medical Conduct (OPMC). When I called him directly the person answering the phone urged me to write an email to him because he “would be happy” to get back to me. Well, not that happy. He never got back to me. When I called back and asked for his voice mail, I was refused, placed on hold, and, voilà, when someone finally answered the phone, discovered I’d been transferred to the office of public affairs! Not surprising given that an August 2012 article in the Albany Times Union  shows any real action resulting from complaints against medical professionals has, well, plummeted with Servis as the helm.

One has to wonder if the DOH’s days as being a non-responsive and at times hostile agency are numbered. They are, if, and only if,  the not-so-new (at this point) governor is as committed as he says he is to making sure state agencies are ethical, responsible, above board, and respectful to the people they serve. If the DOH remains its dysfunctional renegade self, then this writer and others will have to face the fact the governor is not who he wants folks to think he is.

My money is still on the governor, but time is running out.


If anyone is wondering where the Brain Injury Association of NY State and the state’s Traumatic Brain Injury Services Coordinating Council stand on all this, they stand silent.