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.
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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.”
Executives at Magellan, which helps administer the Medicaid programs for 25 states and the District of Columbia, declined to discuss Hanzman’s order.
A spokeswoman for AHCA, Michelle Dahnke, declined to discuss the order, as well, saying the agency was not a party to the proceedings Hanzman described, though his order said both AHCA and Magellan appeared at the hearing.Daniel Armstrong, a psychologist who is associate chair of pediatrics at the University of Miami, said states often “ration” health and psychological care in an effort to control costs.
But, he added, “Florida’s children in foster care are among our most vulnerable. They are in the care of the state because their parents have been unable to keep them safe and well” — sometimes inflicting dreadful abuse and neglect on them.
“As a consequence,” Armstrong said, “mental health, behavioral, and emotional disturbance should be expected, and not something that comes as a surprise.”
Much of the order concerns the plight of a 16-year-old girl, who is not being named by The Miami Herald to protect her privacy. Child protection investigators took custody of the girl from her parents after she disclosed that her birth father had been both molesting her and doing drugs near her.
But what should have been the end of the story became just another ugly chapter: The girl was adopted by her paternal grandfather, who abused her as well.
Around May 2009, the judge wrote, the Department of Children & Families’ abuse hotline received a report that the grandfather was making the girl watch pornographic movies before going into her bedroom and forcing himself on her.
Two months later, DCF took her from the grandfather and sent her to live with a family friend under a permanent guardianship. That arrangement did not last long either; the family refused to accept the girl back after she ran away, plagued by drug abuse and difficult behavior.
For much of the past two years, the girl remained missing.
In April 2011, she told authorities she hated foster care so much that she wanted to return to the grandfather who molested her. While living on the streets, records show, she remained under the sway of pimps who sold her for money.
By November, Hanzman and child welfare authorities were searching for some way to help the girl, who is diagnosed with PTSD, depression and a severe drug addiction. Therapists said she needed residential psychiatric treatment.
A psychologist with Magellan, Charles Winick, spent “only approximately 20 minutes” with the girl, and “failed to review most of her case file,” Hanzman wrote, and arrived at a different conclusion: The girl did not meet “suitability criteria” for a mental health treatment center because her real diagnosis was drug abuse.
With no other options, the girl was sent to live with another relative — and promptly ran away again — most likely, authorities believe, to her pimp. She has not been seen since.