NY State’s DOH Dysfunction Continues

There is no doubt New York’s new governor Andrew Cuomo has his work cut out for him in his push for ethical and accountable behavior on the part of state employees and state agencies. Evidence of the widespread dysfunction is certainly on display in the response I received in yesterday’s mail  to a FOIL (Freedom of Information Law) request I filed on December 12, 2010 seeking documents from the state’s department of health.

The December 12 FOIL request asked for the following (quoted directly from the request itself):

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

And what arrived in yesterday’s mail as a response, a slim binder used to training fair hearing officers. A disturbing and seemingly disingenuous response to say the least. Upon reflection here is what is far more disturbing; I wasn’t surprised.

I’ve filed another, far more specific, FOIL request.

Stay tuned.

Memo to Survivors & Providers: Shine the Light!

If I have learned one thing I have learned that the New York State Department of Health hates publicity. They hate it when their actions are brought into the light of day. And so, given their reluctance to change their clearly punitive behavior towards brain injury survivors, their loved ones and, not incidentally, those who provide services to same across the state, I am urging all of the aforementioned to openly share their stories. Don’t embellish and certainly don’t lie. Simply state the facts of the matter as you honestly know them. The facts speak for themselves.

In yesterday’s Fair Hearing it was crystal clear that the DOH, represented by RRDSs from the Capitol Region, were looking for any excuse to deny my request for white noise machines and a life alert (see preceding blog post). Not only was the tone of their stance, voiced primarily by RRDS Maria Relyea, venomous, it was rooted in a willingness to change the rules at a moment’s notice simply to wound the survivor, in this case me.

Across the state the DOH is looking to jettison people off the traumatic brain injury waiver or, if not that, cutting their services so drastically life becomes even harder for the survivors. I can tell you that living life with a brain injury is not so easy a task in the best of circumstances.

A DOH Trap for Providers

The DOH has also set what might be called a trap for providers. If they don’t tell the provider outright they can’t support their client at a Fair Hearing, they’ll tighten the purse strings by telling the provider if they do appear at the Fair Hearing on behalf of the participant they won’t get paid. A nasty form of manipulation. What’s the trap? Some providers are playing the you need to subpoena us to appear with the participant card. If they are subpoenaed they’re paid, and they should be. However, by playing hat card they walk full length into the DOH’s penchant for accusing providers of being in it for the money. So while the urge to play the subpoena card is understandable, strategically it is a blunder, albeit an understandable one.

Shine the Light

What providers and all others should do when encountering this behavior is  publicize it. Let local, state and national media know. Start a blog, start a web page, or post it on the web page you have. It’s okay to be afraid but don’t let it scare you.

Whatever your political walk of life, there can be no arguing that President Obama was right when he said, “Sunlight is the best disinfectant.”  And if there is anything the behavior of the DOH needs when it comes to the facts just mentioned, it’s a hefty dose of disinfectant.

Shine the light.

No Brain Injury Training for NY RRDSs

The very people hired by the New York State Department of Health to oversee the implementation of the state’s traumatic brain injury waiver receive no mandatory training in brain injury or the brain. 

Two Regional Resource Specialists from the Capitol Region, Maria Relyea and Robert Korotich, acknowledged in a meeting this week that the Department of Health requires no mandatory training in brain injury for RRDSs statewide. 

Given the fact it is the RRDSs who issue the decisions that brain injury survivors will have the services cut or denied altogether, the fact those issuing these decisions are not required to undergo any training about the brain is inexcusable. It’s tantamount to hiring a couple of folks off the street to have them oversee the care of those who’ve sustain spinal cord injuries or are dealing with Parkinson’s  when, with few exceptions, they don’t know anything about SCIs or Parkinson’s.

When you couple this with the fact the state’s Department of Health knowingly signed a contract that will funnel hundreds of thousand of dollars in the direction of Timothy J. Feeney, a PhD wannabe who continues to misrepresent his educational credentials and who has had, according to his own resume, no real training in brain injury, it is hard to reach any conclusion other than the DOH and those of Feeney’s ilk don’t give a damn about those of us who live with brain injuries.

The other conclusion that can be, I think, safely drawn, is the DOH feels it is appropriate to hire people to oversee  the TBI Waiver and directly influence the services waiver participants get or don’t get who are simply not qualified to do so. This is not only unfair, immoral and damaging to brain injury survivors, it is unfair, immoral and damaging to the many companies and individuals around the state who provide services to brain injury survivors. After all, they are expected to following the DOH/RRDS marching orders when the latter tandem knows less about brain injury than the providers do. 

The meeting this week referenced above was the conference I’d asked for that is allowed to take place before a Fair Hearing. My fair hearing is scheduled for December 1. Although I’d written to these RRDSs asking for the conference provided for before a fair hearing, both claimed they didn’t realize this weeks conference was the conference before the fair hearing, claiming that they thought I just wanted to talk about the DOH’s denial of my assistive technology requests.

And just when you thought things could get any slipperier.

Oh, almost forgot. I did inform both Ms. Relyea and Mr. Korotich that I want to have the pre-fair hearing conference with them before the fair hearing. I followed that up with and email confirming this.

NY DOH Wounds Rights of Brain Injured

Reliable sources say the New York State Department of Health has told TBI waiver staff that they must side with the DOH and against their clients when their clients appeal decisions made by the DOH in a Medicaid Fair Hearing.

A Fair Hearing affords people the chance to contest a DOH decision. As regular readers of this blog know, the DOH recently denied this writer’s request for white noise machines and a life alert.

Sources say the DOH Legal Department claims companies and individuals approved to provide waiver services are under contract with the state and therefore it would be a conflict of interest if they were to side with the brain injury survivors, the very people they are supposed to serve. Asked what options waiver staff have if they disagree with the DOH’s decision, sources say waiver staff can help survivors find community advocates to appear with them at the hearing.

The denial of my request came in the form of a letter from the Capitol Region’s Regional Resource Development Center (RRDC).

RRDCs are contract employees of the DOH who oversee those who provide and receive Traumatic Brain Injury Waiver services in their region. The TBI Waiver is an array of services that helps brain injury survivors live in the community. TBI Waiver Providers are companies and individuals who provide these services. Service Coordinators are providers who act as case managers and work with waiver participants in identifying  the services and developing the treatment plans that best serves waiver participants. Essentially, the Service Coordinator is the quarterback of the treatment team that works with and for the participant.

This legal directive was, according to sources, presented to RRDCs across the state in monthly conference calls facilitated by DOH employee Beth Gnozzio. Ms. Gnozzio has developed a reputation on several fronts for not responding to emails or phone calls.

The directive itself appears to violate the DOH’s TBI Waiver manual which reads, in part, that waiver participants must “Receive support and direction from the Service Coordinator to resolve (their) concerns and complaints about services and service providers” The directive’s rather apparent conflict with the manual does not stop there. The  TBI Waiver manual  says (bold is mine): “An individual has the right to seek a Medicaid Fair Hearing for many reasons including issues related to the …TBI waiver”. The manual also says brain injury survivors will “Have your service providers (to) help protect and promote your ability to exercise all your rights; identified in this document”, the document being the manual itself.

How on earth service providers, comprised of service coordinators and, for that matter, all waiver staff, can help protect and promote the survivors ability to exercise their rights, one of which is the right to a fair hearing, while at the same time they are being told they must stand against the survivors in a fair hearing is beyond me.

Dazzling Displays of Integrity

While it is important to hold people accountable for their unhealthy choices, it is equally important to acknowledge and praise people who display the all too rare strength of character, class and courage to step up the plate and accept responsibility for their choices.

So, this blog essay is being written to thank and praise Natalie Marabello and Sunnyview Rehabilitation Hospital and, I would be utterly remiss if I did not single out Dr. James Reed, CEO of Northeast Health (they own Sunnyview) and Edward J. Eisenman, CEO of Sunnyview.

Ms. Marabello and I had two difficult telephone conversations, resulting in my filing a strongly worded complaint, so much so I’d urged that she be fired, something I am, at this writing, genuinely glad did not happen.

During the complaint investigation correspondence moved about including letters to the two CEOs. Sunnyview was so wonderfully responsive their response ought to serve as a template for all. There response was kind, thorough, and in no way sought to duck responsibility. In fact, exactly the opposite. They were and are all about accepting responsibility. A dazzlingly display of integrity.

Today I encountered yet another dazzling display of integrity. I received a wonderful letter from Ms. Marabello. Like Sunnyview’s management, she too did not look to duck responsibility, in fact her words displayed the kind of accountability and class and decency anyone could possibly hope for.

So here’s to Sunnyview and here’s to Natalie Marabello! If all companies and professionals mirrored their actions referenced here, the world would be a better place for sure.