A child welfare judge in Miami has accused the state of denying necessary psychiatric treatment to abused and neglected children in its care, and has ordered Florida social service administrators to appear before him and explain why they have “no duty” to help sick foster kids.
The blistering order by Miami-Dade Circuit Judge Michael Hanzman comes in the case of two siblings, identified only as L.S. and D.S, who are in the state’s care after being removed from their parents. Though Hanzman has ordered the Department of Children & Families to send the two to an in-patient mental health facility for treatment, the siblings remain without treatment.
“This court’s orders are routinely ignored, and children with severe mental health needs are denied critical care,” Hanzman wrote in the Dec. 29 order.
The judge’s order comes at a sensitive time for state healthcare and child welfare administrators: On New Year’s Eve, a federal appeals court judge in Miami released an equally scathing order saying the state had systemically, and for many years, rationed care to impoverished and disabled children insured by the Medicaid program. The failure to provide adequate healthcare to needy children, the judge wrote, violates federal law.
U.S. Circuit Judge Adalberto Jordan, who was assigned the case nearly a decade ago when he sat on the District Court bench, wrote that by refusing to budget enough dollars to meet poor children’s medical needs, the Medicaid program was forced to reimburse pediatricians and specialists well below the market — and sometimes below cost — driving most practitioners away from the insurer. As a consequence, youngsters in rural areas must sometimes travel long distances or wait months for care.
State health regulators have defended the insurer for Florida's needy. "The Judge’s outdated observations pertain to a Medicaid program that no longer exists. Florida’s new Statewide Medicaid Managed Care (SMMC) program is cost-effective and a working success,” the agency for Health Care Administration said in a statement.
The orders follow in a long line of similar missives. In 2012, another federal judge in Miami ordered the Agency for Health Care Administration to pay for a potentially life-altering therapy for children with autism, calling “outrageous” the agency’s claim that “applied behavior analysis” was an experimental treatment.
Speaking for both state agencies named in the order, DCF’s communications director, Alexis Lambert, said the state could not discuss the two children in detail, as their circumstances are confidential under state law.
“The Department of Children & Families and the Agency for Health Care Administration work together to ensure dependent children have access to and receive the mental health care they need to recover from the trauma they have endured. The well-being of Florida’s children is our number one priority, and we remain focused on continuous improvement of our processes to ensure they get the care and resources they need to recover and thrive,” Lambert added.
Hanzman ordered representatives of DCF and AHCA to appear before him on Jan. 25, and to tell him in writing before then why the state lacks treatment beds for foster kids with mental illness. The judge also wants to know how many youngsters are on waiting lists for the beds the agencies have secured. Hanzman ordered DCF to serve AHCA administrators with a subpoena, requiring that they appear in court, if the agency “continues to insist that it is not required to participate in these proceedings.”
D.S. is 10, and his sibling, L.S., is a year older. D.S. has been committed involuntarily for psychiatric care under the state’s Baker Act nine times since Hanzman first ordered that the boy be admitted to a treatment center “equipped to treat his severe mental health needs,” the judge wrote in a footnote. The boy lives in a shelter run by the Children’s Home Society. The five-page order offers little additional detail on the youngsters.
At a hearing on Dec. 22, Hanzman ordered that the two children be sent for treatment to St. Augustine Youth Services, a non-profit, in-patient psychiatric center in St. Johns County, south of Jacksonville. The children’s mother, who has serious financial and health problems, was unable to meet one of the program’s demands: she could not travel to St. Augustine from Miami-Dade twice each month to participate in the children’s treatment, Hanzman wrote.
Instead, Hanzman wrote, the mother said she could travel once each month, and participate in therapy all other occasions through Skype, the computer-based conferencing system. Hanzman agreed to the proposal. But St. Augustine Youth Services, or SAYS, would not. “Despite the fact that it receives most — if not all — of its referrals and revenues from state agencies, the facility did not feel obligated to comply with the Court’s order and nevertheless refused to accept the children,” the judge wrote.
The mental health center’s executive director, Schuyler Siefker, declined to discuss the case, citing the confidentiality of the state’s child welfare system. She did say: “For children in the program to be successful, their parents have to participate.”
At the Dec. 22 hearing, Hanzman then ordered DCF to find another “suitable” treatment facility for the two youngsters within 48 hours. DCF said it could not comply with the order. “As a result,” Hanzman wrote, “the mental health needs of these children are not being adequately addressed, and their condition is deteriorating.”
“Time and again, the Court has been faced with instances where children who qualify for residential treatment...are denied placement due to a lack of available facilities” or the unwillingness of the centers to treat the foster kids, Hanzman wrote.
In the past, DCF administrators have blamed the problem on a sister agency, AHCA, arguing it is AHCA’s job to find bed space at psychiatric centers, and sign contracts with their owners, Hanzman wrote. “Because AHCA has failed to secure a sufficient number of treatment facilities, there is ‘no room at the inn,’ an unfortunate circumstance DCF insists is beyond its control.”
For its part, AHCA has argued that, because the agency is not directly under the jurisdiction of state child welfare judges, Hanzman has no authority to order it to do anything, the judge wrote.
“While these two state agencies point the finger at one another,” the judge wrote, “children with severe mental health needs continue to go untreated” and get worse.
Fran Allegra, the former executive director of Miami-Dade’s Our Kids private foster care agency who now runs the SEED school, a college prep for children in the child welfare system, praised Hanzman’s move.
“The state's agencies are giving this family and the courts the bureaucratic runaround, a game that Florida has become an expert at playing,” she said. “Unnecessary delays like this of critical treatment hurt these children and the family. In the end, we all pay for kids languishing in foster care."