Tag Archives: children
Below is a press release we just issued, announcing a major campaign victory!
FOR IMMEDIATE RELEASE
After advocacy groups’ campaign on behalf of parents of kids with special needs, NYU designates providers who will accept Medicaid and,Child Health Plus
New York, NY, June 1, 2010 – New York Lawyers for the Public Interest (NYLPI), a civil rights law firm whose practice includes health justice and disability rights, along with co-counsel, Cleary Gottlieb Steen & Hamilton LLP and LatinoJustice/PRLDEF, announced today that they successfully campaigned for the Child Study Center of the New York University Medical Center to designate certain doctors who will accept Medicaid and other health insurance. Previously, NYU’s Child Study Center had a cash-only policy for patients, which meant that they did not accept any insurance at all.
As part of the advocacy campaign, which included threats of litigation, a group of parents represented by NYLPI and co-counsel met with NYU leadership and explained how the cash only policy impacted them and the thousands of other families who were unable to access the Center’s state-of-the-art evaluations and medical services for children with disabilities. These services are in extremely short supply across New York City, and without access to the facility at NYU’s Child Study Center, many low-income and minority children were unable to obtain the medical attention they needed.
“NYU has taken a step in the right direction towards eradicating a few of the many institutional barriers keeping low-income New Yorkers from accessing quality health care,” said Nisha Agarwal, director of NYLPI’s Health Justice program. “We still have a long way to go to ensure that all children, regardless of their financial circumstance or background, have equal access to high-quality mental and behavioral health services, but this is one step forward.”
As a result of NYLPI’s action, the Child Study Center has announced that it will designate certain providers who will begin accepting fee-for-service Medicaid and Child Health Plus. Before this change, children and their parents who could not afford to pay cash for evaluations and medical services often went without necessary and recommended medical treatment for serious illnesses.
According to Lorraine Ali, “No mother wants to be told she can’t provide her child with the medical attention he needs. Now I can finally get my son to a doctor who can treat him. It’s the best news we’ve gotten in a long time.”
Although NYU’s Child Study Center has agreed to take the important step of accepting fee-for-service Medicaid and Child Health Plus, it does not have plans to accept any Medicaid managed care plans. “There continues to be an acute shortage of evaluative and medical services for children with psychiatric disabilities in New York City,” said Kelly McAnnany, director of the Opportunity & Access Program at NYLPI. “We will continue to work with providers and with state agencies to open the doors to quality health care and educational opportunity for low-income children with disabilities.”
This piece, by Health Justice Director Nisha Agarwal, will appear in the upcoming issue of NYLPI’s Pro Bono Clearinghouse newsletter. It discusses a case that the Health Justice team worked on in conjunction with NYLPI’s Disability Law Center and advocates from around the country.
Imagine going to a hospital for heart surgery and not being able to communicate with your doctor or any of the nursing staff. Imagine that your 13- and 9-year old children are made to serve as your voice instead: to ask questions for you, to explain the procedures to you, to tell you that post-surgery you had a stroke. Imagine that your children are given pagers and pulled out of school whenever hospital staff need to speak with you, and that the younger child later attempts suicide because he thinks the problems you suffered in the hospital were his fault. After all, his 9-year old vocabulary couldn’t find the right words to describe what was happening — to you, to himself or to others.
These are, roughly, the facts of Loeffler v. Staten Island University Hospital, a case decided by the Second Circuit Court of Appeals on October 6, 2009. Robert Loeffler was a man who was profoundly deaf and sued Staten Island University Hospital for failure to provide him with a qualified sign language interpreter, as required under the Americans with Disabilities Act and the Rehabilitation Act. NYLPI became involved with the case at the appeals level, organizing a broad national coalition of disability and language rights groups to provide amicus support to the plaintiffs. Our brief highlighted two issues: (1) the proper legal standard to apply in “deliberate indifference” cases of this kind under disability law and (2) the importance of having competent, qualified medical interpreters in the health care setting, not just for people who are deaf but also for individuals with limited English proficiency and other communication barriers. Our coalition of amici wanted the members of the court to understand not only the legal right they were being asked to clarify but also, more importantly, its significance.
And understand they did. Oral arguments took place in March and were notable for the impassioned questioning of one judge on the panel, who described as “inhumane” the use of the Loeffler children as interpreters. The court’s eventual decision found for the Loefflers on all points of law and remanded to the district court for trial. In the concurrence, the court concluded, powerfully, by recognizing that the case is “not the dawn of never-ending liability for the Hospital, it is what Congress required – a link to the hearing world.” For NYLPI, the case was an important opportunity to bridge the disability and language access communities and take part in an important victory for many of the communities we serve.
This weekend the New York Times reported on a new study which finds that kids on Medicaid are four times more likely to be prescribed antipsychotic drugs than their privately insured counterparts, and often for conditions for which the drugs are not FDA approved such as A.D.H.D. and conduct disorders. These drugs may not only have significant psychological impacts on the children who take them, but they also cause long-term physical harm. This is terrible no matter what, of course, but let us be very clear about what we are talking about here. In places like New York City, where African-Americans and Latinos are 3.5 times more likely to be on Medicaid than whites, the kids we are talking about are black and brown.
The children who are being systematically over-medicated and denied high quality mental and behavioral health services are disproportionately young people of color. What we are talking about, then, is race even if all but the most oblique reference to it has been scrubbed from the lines of the mainstream media coverage.
Let us also be clear about how this may be happening. The Times piece implies that certain problems with the Medicaid program, such as low reimbursement rates for therapy, contribute to the over-medication of children by creating incentives for doctors to prescribe antipsychotics or by reducing the availability of psychiatrists who accept Medicaid, thus funneling low-income kids to non-specialists who are more likely to provide treatment through drugs. This may very well be true, but let us unpack these dynamics as well from the racial justice tip.
In New York City, where I work, there are large, well-respected institutions providing high quality mental health services for children that refuse to accept Medicaid patients ostensibly because they don’t pay that well. This can be viewed as a rational dollars-and-cents reaction to an inadequate Medicaid system, but when you consider the close relationship between insurance and race, it starts to look like a modern version of Whites Only. Such policies become all the more difficult to swallow when you compare them to the approach of some community-based health care providers that also exist in the city and manage to make mental health services available effectively and equitably.
The directors of clinical services at these community health centers will tell you about how they’ve figured out their administrative and billing infrastructure so they can work around some of Medicaid’s challenges to provide high quality mental health care to all patients, regardless of their insurance. Providers like these fight alongside consumer advocates to preserve Medicaid and make it better because they recognize how critical it is to the lives of their patients. They don’t retreat from the system or take shortcuts, hoping that poor kids of color and their mental health problems will just go somewhere else. Indeed, they bear responsibility for their colleagues at other institutions, who disguise their discrimination in the form of a “rational” economic calculus.
You can expect to hear more about the doping of America’s children in the coming year, as more studies are released and blue-ribbon policy panels convened to address the problem. What you probably won’t see are many efforts to write race into the story or the solution. That is our job as racial justice advocates: to read between the lines and move in from the margins.