Sunday, October 24, 2010

Institutional Racism in Missouri Government

This past Friday, Judge Rod Chapel issued his opinion in the case of Peace of Mind Adult Day Care Center vs. Department of Social Services (DSS), MO HealthNet Division, and Department of Health and Senior Services (DHSS). His ruling excoriates those three bureaucracies for institutional racism. His full opinion is below.

Stephanie Patton, an African-American woman, opened Peace of Mind Adult Day Care in 1993. It was the first adult day care in the Show Me State to specifically cater to African-Americans. Most of Stephanie's clients are poor, so much of her funding came from Medicaid. She was driven out of business in 2009 by the combined forces of DSS, HealthNet, and DHSS. This entrepreneur employed ten people and the DHSS shut her down in the middle of a recession.

I spoke with Stephanie Saturday evening about the past two years.

In October of 2008, DHSS inspectors Cassie Blum and Sharon Buckner conducted a surprise inspection of Peace of Mind. During the inspection Blum asked Stephanie not to accompany them. The procedure during inspections is for someone from the day care facility to accompany the inspector(s). Blum asked Stephanie to not accompany them, but Stephanie insisted. The disagreement devolved from there. Blum called Stephanie the n-word, struck Stephanie, and ultimately called the police on her. When Stephanie asked one of the responding officers why Blum had been so out of line, he told her that he didn't know and added that it "seemed like [Blum] was out to get you."

Judge Chapel agreed. Here's what he wrote [emphasis added]:
Patton testified that Blum called her a "nigger" and said she was illiterate during the October 16, 2008 inspection. We consider this as a claim that DHSS's actions were the result of a racially discriminatory animus and that DHSS's actions deprived Patton of due process and equal protection of the laws, in violation of U.S. Const. amend. 5, 14 and 15, and Mo. Const. art. I, §§ 2 and 10.
The rest of Chapel's ruling reads like a 2x4 to the head, but we first have to return to Stephanie to understand the ramifications that her run-in with Blum would have.

Peace of Mind was operating on Olive in University City. Stephanie had moved her family out to Chesterfield a few years earlier. Her run-in with DHSS was about to get worse. In December of 2008, inspectors  Niekamp and Shelly Williamson arrived for another surprise inspection. In their report, the inspectors noted that Peace of Mind did not have a nurse on duty; however, two nurses were present and on duty during the inspection. Apparently, the inspectors never asked if there were any nurses on duty.

License issues quickly ensued for Stephanie and Peace of Mind Day Care as a result of the false report. The net result of those licensing issues was that Peace of Mind was unable to get Medicaid funding.

By April of 2009 Peace of Mind was out of business. In June of 2009 Stephanie was trying to sell her house to raise money to pay a lawyer. She was worrying that she wouldn't have money to feed her children.  One day, while showing the house to a potential buyer, two lawyers from MO Attorney General Chris Koster's office arrived at her residence. They gave her a large folder of documents and told her, in front of the potential buyer, that they were charging her with half a million dollars of Medicaid fraud ($487,462.08 to be exact).

This was devastating. Stephanie's home went into foreclosure, she had to sell her car, and she suffered severe depression. As Judge Chapel notes:
At the time of the hearing, [Stephanie] was emotionally distraught, but otherwise was able to testify.
While discussing the trial with Stephanie, I learned that the court reporter was so moved by what she heard that she too was crying during the testimony. The collapse of the business and with it Stephanie's life was precipitated by the false report that there wasn't a nurse on duty. As Judge Chapel notes [emphasis added]:
We have found that Peace of Mind had a nurse on duty at all times. There is not a basis for sanctions under Regulation 13 CSR 70-3.030(3)(A) 12.
DSS argues that Peace of Mind failed to maintain a license, as required for participation in the MO HealthNet program. DHSS granted a provisional license for a social model to Peace of Mind for a limited time. We have found that Peace of Mind had a nurse on duty; thus, there was no reason not to continue Peace of Mind's license as a medical model. We find no basis for sanctions under Regulation 13 CSR 70-3.030(3)(A)13 for failure to meet program requirements, such as licensure.
The judge also ruled that because Stephanie did not have any prior sanctions from DHSS, going after her for $487,462.08 of Medicaid fraud was not justified. He noted that DHSS never required provider education or other available remedies. With 15+ years of service, they decided to throw the book at her. From the ruling:
We also conclude that the sanction of termination of Peace of Mind's status as a MO
HealthNet provider was not warranted. There has been no allegation or showing that Peace of
Mind provided substandard services, committed any fraud, or failed to perform any service for
which she received payment.
We conclude that Peace of Mind is not subject to MO HealthNet sanctions.
As Peace of Mind was dealing with licensing issues in late 2008 and early 2009, they were still caring for patients. However, their Medicaid claims to the tune of $45,340 were denied. Without revenue to pay her operating costs, Stephanie had no choice but to wind down her business. The closing summary of ruling provides:
[Stephanie] is entitled to payment of$45,340 for services rendered from December 20, 2008,
through February 20, 2009.
During her ordeal, Stephanie reached out to leaders in Jefferson City, MO. She said that the Missouri Legislative Black Caucus was unresponsive. Jay Nixon did not return her calls. Margaret Donnelly Director of DHSS was unresponsive. Interestingly, Donnelly represented Stephanie before Stephanie moved to Chesterfield. Cole McNary, her current state rep, took the time to hear her story, was instrumental in setting up meetings, and sent a supportive letter to Judge Chapel.

Stephanie also reached out for support to friends and family. One of those friends is Jacque Ehrlich (the Missouri state chairmom for Jacque provided both moral and professional support including testifying on Stephanie's behalf. Stephanie was never able to raise money for a lawyer. As a paralegal, Jacque was able to provide some advice; however, Stephanie represented herself in court. She took on the system and their lawyers and with God's help she prevailed. While talking about her ordeal, the most poignant moment was when she told me: "I thank God for this affliction."

Grace. It truly is amazing.

Updates added 10/24/2010.

Rod Chapel No. 09-0304 SP

1 comment:

Joy Wooderson said...

The Power of God’s Punctuation

I read with particular interest your blog about Institutional Racism in Missouri Government, the case involving Stephanie Patton and several departments in the State of Missouri.

I watched from the sidelines as this case developed; I prayed for Stephanie and her family; I shared her anger at the injustices she suffered. I observed how life as she knew it eroded from under her feet like sand washed away on a beach. I saw the “For Sale” sign outside her home as a result of bank foreclosure. And my heart broke for her and her family. All I could do was pray that God would graciously intervene on her behalf.

I heard how Stephanie experienced a roller-coaster ride in her faith journey, confused how her attempts to handle her business ethically and above-board had backfired. God appeared distant and uninvolved, and the future looked bleak. But throughout the two years of this saga, although she could never understand her circumstances, she clung to her belief in a good God.

Stephanie’s comment, “I thank God for this affliction,” reminded me of the power of punctuation. Psalm 34 relates King David’s despair over difficult circumstances, and in verse 19 he writes “Many are the afflictions of the righteous . . .” which seemed to sum up Stephanie’s situation. A grim outlook indeed. However, the writer then adds significant punctuation to indicate a dependent clause—a semicolon. The verse now reads, “Many are the afflictions of the righteous; but the Lord delivers him out of them all.” David could, in his misery have placed an exclamation point after the first clause, “Many are the afflictions of the righteous!” Instead, he leaves us with hope that God, in His timing, will intervene.

Many have been Stephanie’s afflictions, but the Lord has vindicated her and honored her steadfast faith.

God’s punctuation always introduces hope in hopeless situations.

Joy Wooderson, author of Finding Joy: One Woman’s Journey Back to Faith