Advocates Call Out Institutionalization Cycle in Washington

WASHINGTON (CN) - Representing minors who have been bounced around psychiatric hospitals and group homes in Washington, D.C., children and disability advocates claim in a federal class action that the district is shirking its duty to provide intensive community-based services.

Filed on Aug. 14 on behalf of lead plaintiffs M.J. and L.R., the complaint says that the needless institutionalization of Medicaid-eligible children creates a dangerous cycle and deprives the class of proper follow-up care.

M.J. is described in the complaint as a 14-year-old who has been hospitalized nine times since 2014. In addition to numerous school changes and suspensions, M.J. was arrested in 2016 for assaulting her mom. M.J. loves writing, dancing, cooking and animals, and would like to become a veterinarian. According to the complaint, the district has ignored requests  by M.J. and her mom for help in crafting a plan to help the girl avoid further institutionalization.

At the law firm Schulte Roth & Zabel - which brought M.J.’s suit with the Judge David L. Bazelon Center for Mental Health Law, Disability Rights DC at University Legal Services and the National Center for Youth Law - they say children like M.J are being segregated and discriminated against in violation of the Americans with Disabilities Act.

"For many years, the members of the co-counsel group have attempted to get the district to address these issues and comply with its legal obligations," Howard Schiffman with Schulte Roth & Zabel said in a statement.

These advocated were compelled to file suit now, Schiffman added, because more than four months of pressure failed to move the district. "We have been in contact with the district since April," Schiffman said, "urging in letters and an in-person meeting that it recognize these shortfalls in necessary services and the harm they are causing, in hopes that the district would promptly address those problems without the need for litigation.  The district's unsatisfactory response to those efforts led us to file this lawsuit."

Under the Medicare Act, the District of Columbia must provide medically necessary treatment services to children with physical and mental health conditions and illnesses. That includes intensive community-based services for Medicaid-eligible children, even if not included in a state's plan, "to correct or ameliorate the child's mental health disability."

Intensive community-based services include care coordination among various providers to coordinate necessary services, along with frequent and consistent behavior-support services and mobile crisis services.

But the lawsuit alleges that no service providers in the District of Columbia offer intensive community-based services, despite having faced criticism for years that the absence of such services hurts children.

"Years of reports from researchers, advocates, and the district itself, as well as testimony before the district council, indicate that district children do not get the ICBS they need," the complaint says, abbreviating intensive community-based services.

According to the lawsuit, providing these children with intensive community-based services would allow them to live at home or with a foster family, integrate with their nondisabled peers, and succeed at school and community activities.

The outcomes for children who receive these services are better, too, the advocates say. They fare better in school, have fewer contacts with law enforcement and have fewer suicide attempts, as compared with those segregated in institutional settings.

According to the complaint, it's "impracticable" to count the number of potential class members the lawsuit could cover.

"There are thousands of Medicaid-eligible children in the district with a 'serious emotional disturbance,’” the complaint states. “In fiscal year 2017, over 300 of these children were admitted to a psychiatric hospital or placed in a psychiatric residential treatment facility. Over 100 of them had multiple admissions."

Had the city provided these children with the medically necessary intensive community-based services they are entitled to under Medicaid, according to the complaint, most of these hospitalizations could have been averted.

The lawsuit names as defendants the District of Columbia; D.C. Mayor Muriel Bowser; Tanya Royster, director of the District of Columbia Department of Behavioral Health; and Wayne Turnage, director of the District of Columbia Department of Health Care Finance.

The District of Columbia Executive Office of the Mayor did not immediately respond to a request for comment on the lawsuit.

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