The 16-year-old girl is being raised by the state because she was repeatedly molested, first by her father and, later, by her grandfather. She has endured so much anguish that she has been diagnosed with the same illness as many combat veterans, post-traumatic stress disorder.
Her therapists say she desperately needs residential psychiatric care. State healthcare administrators refuse to pay for it — saying she is a drug addict, not a child in need of mental healthcare.
In the latest clash between Florida’s embattled healthcare agency and children’s advocates, Miami-Dade Circuit Judge Michael Hanzman is accusing the Agency for Health Care Administration of concocting misleading mental health evaluations to avoid providing basic and necessary services for children in state care.
“This court has been increasingly concerned that dependent children are being denied much-needed treatment for mental health disorders — contrary to the first stated purpose of [child welfare law], which is to provide for the care, safety and protection of children,” Hanzman wrote.
The three children in Hanzman’s 38-page, Feb. 1 order are among about 19,000 in state care.
AHCA already has drawn harsh criticism in recent months over claims it is cutting in-home care to severely disabled children so deeply that many parents have no choice but to warehouse their children in geriatric nursing homes.
In that case, as in Hanzman’s order, advocates claim the healthcare agency is paying a private company to justify sometimes deep cuts in services to the most needy.
In both cases, the agency has been accused of employing arbitrary criteria to produce the result it desires: spending fewer dollars to provide care.
Late last month, Hanzman held a fact-finding hearing to determine whether Magellan Health Services, AHCA’s contractor, was producing erroneous psychiatric evaluations of foster children as a “pretext” for denying costly psychological care. He concluded that, indeed, they were.
Here, according to Hanzman, is how the system works: Often the victims of horrific abuse, many foster children suffer from severe mental illnesses, such as depression and post-traumatic stress disorder or PTSD. Many of the youngsters also use drugs and alcohol as a way to self medicate. If a child has a serious psychiatric diagnosis, such as depression, but also abuses drugs, psychologists at Magellan will conclude that the child’s “primary” diagnosis is drug addiction, the judge said.
Why? Because, while the state has beds available for psychiatric care for children, it has virtually none for residential drug-treatment. If the beds aren’t available — or if the state does not have the dollars to pay for them — health administrators can’t be forced to provide the treatment, Hanzman wrote.
What’s more, Hanzman wrote, Magellan psychologists who evaluate foster kids are writing in their reports that children with mental illness will not “benefit” from drug treatment — not because it won’t help them, but because it’s unavailable.
“Acceptance of this ‘reasoning’ results in a bewildering circularity: a child with the mental health disorder of substance abuse will not benefit from residential treatment because the state does not provide it,” the judge wrote. “The court rejects this puzzling logic.”