Advertisement

4 Disabled People File Suit Seeking Home Care

Share
Times Staff Writer

Four disabled people sued the state’s health agency Friday over a policy that they say forces the disabled to stay in hospitals at a cost to taxpayers of up to $1,500 a day because the state does not provide enough funds for in-home nursing, which is often far cheaper.

The state pays $14.90 to $15.45 an hour through Medi-Cal to care for the plaintiffs at home, but both sides agree that nursing fees actually run about $19.20 to $23 an hour.

Families of plaintiffs in Los Angeles and Northern California said they have spent months looking for nurses willing to work for the lower Medi-Cal reimbursement rate, but dozens of private health care agencies have turned them down.

Advertisement

Five public-interest groups representing the families said three of the plaintiffs--who require nursing help because they rely upon tube feeding or need ventilators to breathe--are being forced to live in hospitals needlessly. A fourth, a brain-damage victim, faces returning to the hospital if funds dry up.

Injunction Sought

The lawsuit, filed in Sacramento Superior Court, seeks an injunction against the state Department of Health Services to ensure that three of the plaintiffs, including the one who is still at home, be given home health care. A fourth plaintiff was found ineligible for home care by the state. The lawsuit challenges the standards used to disqualify her.

Officials of the Department of Health Services refused to comment on the lawsuit.

One of the most poignant cases cited in the suit is that of Dennis Funes, 5, of Los Angeles, who requires a ventilator to breathe.

Since September, his parents have been forced to keep him in Los Angeles County-USC Medical Center’s pediatric intensive care unit because no nurses will accept his case at Medi-Cal’s lower rates.

Child ‘Runs for Elevator’

In court documents, the boy’s mother, Laura Funes, said that before he moved to the hospital, Dennis loved attending school, had learned all his colors and letters and could operate a computer.

Now, she said, he is a withdrawn, frightened child whose development has been dramatically stifled and who sometimes strikes both parents when they visit him because he believes he is being punished.

Advertisement

When she takes Dennis for walks in the corridor, Mrs. Funes said, “he runs for the elevator” and tries to go home. He also has begun hiding his clothes in the trash, believing that if he has no clothing “we will have to take him home.”

Marilyn Holle, an attorney for Protection and Advocacy Inc., a public-interest agency representing the family, said Dennis is “a healthy child in a hospital ward of gravely ill children. Many children have died since he got there, and now when a new child is brought in, Dennis starts to cry. He wants to go home for Christmas.”

Another plaintiff, John Lindsay of San Jose, who was paralyzed by polio in 1985, said in his court declaration that he sometimes thinks, “Why keep us alive? . . . It feels cruel to keep us alive when we can’t go home and go on with our lives.”

Attorneys for the families said the state has embraced a “Catch-22” policy, refusing to raise Medi-Cal reimbursement rates for home care but actually spending far more to pay the skyrocketing costs of hospitalization.

“I have tried to make sense of it, and I cannot,” said Jane Perkins of the National Health Law Program, which is also representing the plaintiffs.

“What we have here is a pound-wise but penny-foolish situation that is cheating the taxpayers, and it is happening all over the state,” Perkins said.

Advertisement

A spokeswoman for the state Department of Health Services, Kassy Edgington, said her department’s budgetary policies are intended to “get the biggest bang for the buck.”

However, she conceded that families who qualify for home nursing care face a difficult time finding nurses, in part because such medical cases are often troublesome, but also because of the lower wage scale paid by Medi-Cal.

“Why would a nurse take less money? It’s a good question, but it’s no different than asking why doctors take less money for Medi-Cal,” Edgington said. “Some of them do.”

However, in the Funes case, the hospital bill has already topped $300,000 for care that would have cost the state only $15,000 if Dennis had continued to live at home, according to Perkins.

Perkins said Dennis was taken to County-USC after a private agency that had cared for him at home for one year decided that it could no longer accept Medi-Cal.

A second agency was found, but it was dropped by the Funeses after numerous problems occurred, including an incident in which Dennis’ parents discovered a nurse preparing to inject their son with four times his normal dose of phenobarbital.

Advertisement

The Funeses said they then contacted every private agency on a list provided by the local Medi-Cal office, but none would take on a Medi-Cal case.

A county social worker, Antoinetta Medrano, and a county consultant, Jan Ensley, said in a joint court declaration that they contacted Jerry Burns, a Medi-Cal representative in Sacramento, and were told that “Medi-Cal has no intention of raising its rates.”

Advertisement