State Faces Lawsuit over Mental Health

Thanks to Sarah Sommers, Jane Perkins and Doug Sea. Send a contribution to support their efforts: www.lssp.org and www.healthlaw.org

State Faces Lawsuit over Mental Health
Raleigh N&O
Lynn Bonner, Staff Writer

Two law firms that represent low-income people are suing the state over mental-health care, contending that patients are having their services taken away without good reason.
Legal Services of Southern Piedmont, based in Charlotte, and the National Health Law Program are suing Dempsey Benton, secretary of the state Department of Health and Human Services, on behalf of a 12-year-old boy with an inherited condition that can cause learning and behavioral problems.
The boy, Devon Tyler McCartney of Robeson County, is autistic and epileptic. His hours with a mental health worker paid by Medicaid were cut last year from 28 a week to 21 a week until he eventually lost services in January, according to the lawsuit.
Tyler's behavior got worse when he no longer had a mental health worker go to school with him, the lawsuit says. Tyler's school would not allow him to attend for six days last month because he threw multiple tantrums each day. He was allowed to go back to school, but his mother often gets called to pick him up "because the school cannot handle him."
Patients trying to get services restored are a growing problem for the state and one of many symptoms of the state's failed mental health reform effort.
The state asked ValueOptions, the company it hired to approve services for Medicaid patients, to more carefully examine requests after costs for a basic service called community support rose exponentially. A recent News & Observer investigation showed the state has wasted at least $400 million on the service, which has been billed at as much as $61 an hour.
In response to the crackdown, thousands of people appealed decisions to cut their care.
A range of services, not just community support, is being reduced, said Douglas Sea, the legal services lawyer.
The lawsuit was filed in federal court last week, and lawyers intend to seek class action status, arguing that Tyler's situation is an example of the way the state violates patients' rights. ValueOptions, acting as a state agent, pushes providers to limit their requests for time with patients, the suit says, and denies services without considering patient needs. The suit claims many problems with the appeals process, among them that ValueOptions mails decision notices after the time for appeals has passed and that the informal hearings at which state employees make decisions about patient care are unfair.
Sea said he had been talking to the state about improving appeals for about four years and about problems with ValueOptions since last summer. The two sides were still talking as of April 4, he said, but negotiations broke down.
Tyler's mother, through Sea, declined a request for an interview. Brad Deen, a DHHS spokesman, said the department would not comment on ongoing litigation. The spokesman for ValueOptions could not be reached.
To handle the appeals backlog, Benton has proposed having people who want services restored and don't like what the department hearing officer has decided go straight to Superior Court, skipping a formal appeal before administrative law judges.
Sea said it would be better to get rid of the informal department appeal and make the appeals to the administrative law judges a high priority.
"An independent review of administrative decisions is critically important in Medicaid cases," Sea said.
lynn.bonner@newsobserver.com or (919) 829-4821