Miami Herald: How Florida limits care for disabled kids

In a drab, cramped conference room in Doral, a 45-year-old single mother is fighting with the state to secure in-home nursing care for her severely disabled daughter — while the 10-year-old fights for her life.

The mother sits across a wooden table from a state hearing officer who will decide whether health regulators were right to insist she get 18 hours each weekday of nursing care for her daughter, and fewer on the weekends, instead of the 24 hours her daughter’s pediatrician says are necessary. As her expert witness — a registered nurse — testifies, the woman’s daughter begins to cough, then vomit, then struggle for breath as her breathing tube becomes clogged. The hearing stops as the child’s mother and the nurse suction the girl’s tube, then clean, change and console her.

Generally lacking in such drama, hearings like the one that occurred Dec. 14 are held hundreds of times each year in Florida as the parents of severely disabled and medically fragile children battle state health administrators for nursing care and services for their children. Without such care, some of the youngsters will end up in nursing homes, something the 10-year-old’s mother is trying to avoid.

Let the article simmer with you a minute. Every attorney and child advocate in Florida should take one or two of these cases. We should make it a short-term goal that no parent ever has to walk into that hearing room alone. The long-term goal: this system has got to go.

I sat in the school’s food court today underneath a television showing news coverage of the Sandy Hook Elementary shooting. People around me stopped and stared. Some turned away; others called people over to see. I have no words.

Free Parking – Is the new Miami juvenile courthouse really more accessible?

Alan Mishael has been up to some provocateuring for justice with his Request for Information on Free or Reduced-Rate Parking For Volunteers and Poor People at the New Juvenile Courthouse, and the AOC’s soon-to-be-famous response of “let them valet.”

I am very excited about the new courthouse. I have never missed an opportunity to point out that the current Juvenile Courthouse stands as a dilapidated architectural witness to the benign neglect of the families and children that pass through the dependency system. I applaud everyone who has worked hard to get this accomplished, because many thought they would never live to see it.

But, I think the parking question is a valid one: for all its warts, the current JCC at least has some kind of parking law immunity that allows people to leave their cars on any reasonably flat surface and have nobody say anything about it. (Just don’t park in the circle in the front because blocking access to the churro cart will get you towed faster than whatever period of time the clerk’s office is answering the phones these days.) It’s not just court personnel who go there daily: volunteer GALs, case managers, police officers, pro bono attorneys, grandmothers, aunts, uncles, and parents. This will add a $6 surcharge for each court trip, sometimes just to have their hearing reset.

bus-to-new-courthouse

Much was made in the AOC response letter about the fact that the new courthouse is right on the Metrorail line. (Also: they recommend you use jitneys? lol.) I wondered how much time that would actually save parents and relatives coming from all over our unnaturally (or naturally, which is the problem) shaped county. The answer: some, but not much. Using Google Maps as a reasonable estimate, I calculated the travel schedule required to get someone to a 9:00am hearing at the New Courthouse versus the Old Courthouse. As you can see below, the biggest winners are those in Kendall, Homestead, and North Beach, who save 26-28 minutes. The biggest losers (or non-winners) are those in Carol City and Liberty City. Hialeans kind of break even. Thirty minutes is no small amount, but it won’t prevent someone from losing their job(s) when they still have almost two hours of travel time each way. Case managers from His House Children’s Home in North Miami would spend two hours in transit each way (sometimes having to take a bus, the Tri-rail, and then the Metrorail), versus 25 minutes driving.

To New Courthouse To Old Courthouse
From Leave by* Connections Transit Time Leave by* Connections Transit Time Time saved
Carol City 07:43 3 01:12 07:34 3 01:07 -0:05
North Beach 07:52 2 01:03 07:24 2 01:29 00:26
Hialeah 08:05 2 00:48 08:05 2 00:53 00:05
Miami Beach 08:15 1 00:38 07:54 2 00:53 00:15
Liberty City 08:15 2 00:34 08:25 2 00:29 -0:05
Kendall 07:57 2 00:49 07:32 3 01:17 00:28
Homestead 07:13 2 01:44 06:38 3 02:11 00:27

* Time you would have to leave in order to arrive at the courthouse by 9:00am. 

Students of South Florida geography will immediately note that the New Courthouse seems to have become more accessible to people based on their race and social class. That says more about public transportation in Miami than any prejudice by the courthouse planners. Maybe this will be an opportunity for MDT to recalculate some routes to make the courthouse more accessible.

Still, having a courthouse nearly two hours away from a community it serves seems indefensible. It has been floated for years and I float it again here: dependency court should have satellite hearings. Once the files are electronic (hahaha), there is no good reason not to hold court in Homestead and North Miami once a week and conduct motions hearings and other non-witness hearings by teleconference. This will require a lot of planning, yes, but we will have plenty of time to do that while we’re sitting in our jitney at 7:13 in the morning.

Conclusion: The New Courthouse is good. The lack of low-cost or free parking is bad. Miami public transit is rotten. We can always do better and should try.

The Shaken Baby Battle

In this case, McDonald moved for the appointment of board-certified neurosurgeon Ronald Uscinski, who the defense expected to opine that shaken baby syndrome rests on “flawed science,” and to testify to innocent medical explanations for E.M.’s injuries. A representative of the Justice Administrative Commission (“JAC”) appeared in opposition to the request, but confirmed that the JAC was not aware of a less expensive in-state expert whose testimony could be expected to aid McDonald’s defense in this fashion. The State has offered nothing more than argument to contest McDonald’s position that the science it relied upon to secure a conviction is unsettled or that there are equally qualified experts who disagree with the positions taken by its experts. Yet, the State argues that due process was satisfied in this case when it offered to pay for the services of a local expert whose opinions would mirror the opinions held by its experts.

McDonald v. State
— So.3d —-, 2012 WL 5969648
Fla.App. 5 Dist.,2012.
November 30, 2012 (Approx. 1 page)

Noting that the State’s case relied almost exclusively on medical testimony, the Fifth DCA authorizes the retention of the defense expert, hints that a Frye test should be in the offing, and allows the Shaken Baby Syndrome battle to begin. I have seen many clumsy attempts to challenge Shaken Baby Syndrome in dependency court, usually resulting in CPT doctors screaming at defense attorneys YOU DON’T KNOW WHAT YOU’RE TALKING ABOUT. We will wait and see if Mr. McDonald’s attorneys fair any better.