The day Dr. Mary Ehlenbach visited Kidz Korner, a residence for children with multiple medical needs, and found the boy locked in one of two stalls in a large space. The boy seemed to be excited by the visitors, but when he lowered his throat into the manger, he ran away.
“He’s running away,” Ehlenbach, medical director of the University of Wisconsin (UW) Pediatric Comprehensive Care Program, said in a recent trial. “He jumped out of bed and slammed the door.” The worker was “intercepted”.
The fate of the boy, like 139 other Florida children living in institutions, no longer depends on nursing home employees, or even the state health administrators who kept them there for 12 years, but now in the hands of the US District. Judge Donald M. Middlebrooks, who presided over a civil rights lawsuit brought by the US Department of Justice (DOJ) against state regulatory authorities.
Middlebrook seems to want to do what civil rights leaders and child advocates have long failed to do: help the free boy and others like him.
“Thus, I believe that the United States has met its burden of showing that the state of Florida has diminished the civil rights of medically challenged children in foster care,” Middlebrooks said, concluding his testimony on May 19 after a two-year trial. .
But the judge declared that he wanted to act quickly. “United States citizens in 2012 and one of the tragedies in the case is that it took more than 12 years to go to trial, which I think is a failure of the judicial system,” Middlebrooks said.
The judge said: “One way,” he said, “I hope this is not permanent… I believe if they want to litigate and deal with this for years, but it will certainly happen.” t solve anything”.
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In a landmark decision in 1999, the US Supreme Court ruled that it was a violation of the Americans with Disabilities Act (ADA) and a form of unlawful discrimination to force people with disabilities to live in institutions. However, according to the DOJ, Florida health administrators have placed restrictions on parents who chose to educate their children at home, forcing them to turn to a life of loneliness and isolation in nursing homes.
An exterior view of the Plantation Nursing and Rehabilitation Center and Kidz Korner on Wednesday, April 19, 2023 in Plantation, Florida.
Florida health administrators have fought the case for 12 years. Lawyers for the Agency for Health Care Administration (AHCA), which oversees the medical centers, said the lawsuit threatens the state’s own government and allows the agency to home, care and take care of people’s finances without interference from federal authorities.
The state declined to disclose how much it paid Gray Robinson, its roughly 255-attorney firm, and did not respond to a request for billing information made public.
The long-awaited trial began on May 8. Although Middlebrook had heard testimony from several parents, there was much controversy among the experts.
Dr. Allan Greissman, an acute care pediatrician at Joe DiMaggio Children’s Hospital in Hollywood, testified that many children living in foster homes are too fragile to survive outside of long-term care and that, in fact, many were. They were neurologically devastated and could not experience the joy or comfort of living with a family.
“I reject the expert testimony in this case. […] who expressed some problematic views, “Medelbrooks, who is in charge of the West Coast Palm Beach, said from the bank, “that some children do not derive any benefit from family interaction in the home environment.”
“In short,” Middlebrooks said, Greissman “suggested that institutional nurses are better at caring for children. Therefore, they have established a safer environment that justifies their children in nursing homes.
Middlebrook said the testimony was “neither credible nor persuasive.”
Middlebrook’s tentative conclusions suggest that he believed Ehlenbach’s testimony, as well as the persuasiveness of other DOJ experts. Ehlenbach toured three Florida nursing homes that receive pediatric patients, interviewing the parents of the children living there and reviewing medical records.
In his testimony in May, Ehlenbach painted a grim picture of life for 140 children living, sometimes for life, in long-term care.
“I think I was mostly left with the impression that even though they were surrounded by people, they were very lonely,” he said. “He felt alone.”
“Most of the children we saw in the three seats of care were in bed looking at the screen or in wheelchairs, sometimes in the bed, sometimes in the room; sometimes they were watching the scenes, sometimes they were just above the scenes.”
Ehlenbach recounted the most disturbing incident of his visit to The Kidz Korner, a 100-bed pediatric unit at the Plantation nursing home: “the beds were with metal bars on four sides … but they were bigger than a traditional baby crib.” he said.
“And one of the children, when he saw someone coming into the room, got up and moved around the bed, indicating to us that he wanted to get out of bed, and he put down his side. He scolded me and… .. the boy ran away.”
A staff member of the residence intercepted the boy and returned him sadly to the bed of the compound. You might say he was disturbed; You could tell he wanted to interact with us,” Ehlenbach said. “It’s something that has stuck with me.”
District Judge M. Donald Middlebrooks.
“Are there children in any capacity that you feel are not medically fit to live in the community?” DOJ attorney Lauren Latterell Powell told Ehlenbach.
“No,” he said.
“Are there any children who live in the middle, whose state is such that housing affords them the safest place to live?”
“All children with medical problems who have access to appropriate support and services at home and in the community can live safely with their families,” Ehlenbach later said.
During questioning, state attorney John A. Boudet said Florida sometimes has to use foster homes as a “bridge” between when children are released from the hospital and can live safely with their parents. He asked if Ehlenbach had reviewed the children’s records sent home.
A lot of these have been established for years and years,” Ehlenbach said, which is going to be quite a long time for me.
Most of the trial’s evidence reached a major hurdle at the time: the profound lack of private sector support services in the state. Without adequate home care for children who need breathing tubes, for example, many parents have no choice but to keep their children in foster care.
In that speech, Middlebrooke said that “the most serious problem is that the state does not provide family members with private services of nutrition.”
“And this, of course, was compounded by the horrifying stories I heard from many desperate parents, about their personal experiences trying to care for their fragile children in unimaginable conditions without adequate and reliable nursing support,” said the judge.
Middlebrooks suggested that the nursing shortage would only be an obstacle if Health administrators did nothing about it: “The state certainly shows that there is a nursing shortage,” he said. “What I don’t think should be shown is that they can then say: Well, there is a shortage of nurses. We can’t do anything about it.”
At the conclusion of the trial, Middlebrooks urged lawyers from both sides to negotiate an agreement that would end the institutionalization of children with the most serious medical needs in Florida, but he also added something else: He said it is likely to order the state to make real reforms. if sane administrators do not receive them sooner.
On Wednesday, the attorneys for both parties briefed the judge that they had not reached an agreement as to how the crisis could be resolved: “At this time, the parties are not anticipating an agreement on the language that could be included in the court’s permanent order or one that would be a settlement.”
On May 19, Middlebrook rejected the idea of keeping his jurisdiction over the long-running case and assigning a judicial officer to oversee the state’s commitment to reform. He said that these types of agreements are often simply postponed without any progress.
“If we’re going to do something,” Middlebrook said, “let’s do something that makes a difference.”
The judge said he was “committed to bringing this case to a conclusion without undue delay.” I don’t want to contribute any more to that 12-year delay.
“I’m not looking for something that drags on for years, because it’s not a long-term problem because the parties are identified in this case,” the judge said. “In my opinion, this case is too long.”