Wednesday, June 23, 2010


Class action lawsuit filed against Hawaii Department of Health to reverse cuts in mental health services

by Larry Geller

Yesterday (6/22/2010) the Hawaii Disability Rights Center, long with Alston Hunt Floyd & Ing, filed a complaint in federal court in an effort to halt devastating, perhaps deadly, cutbacks in Hawaii’s adult mental health services.

Hawaii has aggressively cut back on services delivered to adult mental health patients by the state Department of Health. It is likely that these cutbacks have resulted in the increase in deaths that was reported in sworn testimony given to the Legislature in March:

A measureable and significant increase in avoidable deaths was reported in testimony given to informational briefing on state administration cutbacks in adult mental health services on Tuesday, March 16, 2010. This briefing was an opportunity for the public to give testimony, following previous briefings by the administration.

The first testimony was taken under oath, and after just a few minutes the news came out—a 36% increase in deaths 2009 over 2008 has been recorded.    [Hawaii’s deadly cuts in mental health services demand state response, 3/18/2010]

The state did not respond, however. Legislators present at the hearing (see video at the link) stared at each other but took no action. The Department of Health is proceeding with its plan to transfer adult mental health patients to the troubled QExA program, a managed care program run by two Mainland health insurance giants. The transfer will solidify and deepen the cuts already made by DOH.

See also: Tantalus shooting linked to DHS Medicaid program failure (5/11/2010) for an example of the consequences of cutting medication.

Snipping from the complaint, which is posted in its entirety below, demonstrates the extent of the cutbacks. I’m including this detail because without it it’s impossible to get a sense of how much the DOH has slashed and decimated mental health services it is responsible to provide.

In September 2008, AMHD closed its Assertive Case Treatment program, which had provided 24-hour case management to seriously mentally ill adults.

In January 2009, AMHD reduced its case management hours from 3 per week to 3.5 per month.

In the Spring of 2009, AHMD eliminated case management hours provided to mentally ill individuals with private insurance.

Prior to July 2009, AMHD determined eligibility for its services under policies and procedures adopted in 2004 (the "2004 Rules'')

In July 2009, DOH adopted new policies and procedures under which AMHD restricted the eligibility of mentally ill persons and reduced the medication, services, and treatment available to those who remained eligible for its services. …

Among other things, the new rules altered the eligibility criteria for AHMD's services, eliminating coverage for, among others, individuals with post traumatic stress disorder, obsessive compulsive disorder, borderline personality disorder, and most cases of depression.

The new rules eliminated, among others, the following services previously provided by AHMD:

Shelter Plus Care for the homeless;
Outpatient treatment;
Assertive Community Treatment;
Community-based intervention;
Supported education;
Warm Line;
Consumer Support Groups;
Respite; and
Family Education.

In addition, the new rules: (1) reduced staffing levels at residential facilities from 24 hours to 8-16 hours; (2) de-funded parent education and support groups; (3) eliminated psychological rehabilitation services; (4) significantly reduced staffing levels at AMHD facilities.

When it implemented the new rules, the DOH:

a. Denied continuing benefits to some mentally ill adults who were theretofore entitled to—but had not yet received—services from the AMHD.
b. Reduced the array and amount of services and medication provided to adults who remained eligible under the 2004 Rules for medication and treatment, and,
c. Refused medication and treatment to mentally ill adults who would have received services under the DOH's preexisting policies and procedures.

I was personally glad to see that the approach taken in this lawsuit was that the DOH conducted these cutbacks without creating new rules. Although your humble blogger doesn’t take any credit for this and had no part in it, I did mention to one of the attorneys outside the March 16 hearing room at the Legislature the approach used in Babson v. Cronin. That case, argued successfully by Maui Attorney Lance Collins, enjoined the use of electronic voting machines in Hawaii because the Office of Elections did not have administrative rules that permitted their use. Instead, as the Department of Health has done, they created their own rules whole cloth and outside the law, and without public hearings.

Remember also that the governor attempted to close the Molokai Clubhouse at the end of December, 2009, by laying off its single employee. Action by readers of this blog, advocacy organizations and the Honolulu Metro Rotary Club succeeded in restoring the position and keeping the last facility serving Molokai consumers open. Further action was needed to restore staff (full report on this later).

We’ll follow this case as it progresses. You can download a copy of the complaint from the links below or read it full screen by clicking on the button on the top line.



Great information, thanks for your hard work. Just wanted to clarify for the record, as an employee of the State of Hawaii for over 10 years I think the following information is important and in fear of getting rifted I must remain anonymous.

Alston, Hunt, and Floyd filed a lawsuit on behalf of the Hawai'i Disability Rights Center in the First Circuit Court State of Hawai'i asking for injunctive relief on June 22, 2010.

The defendant in this case is the Department of Health (DOH) Adult Mental Health Division (AMHD) which claims are based on cuts to services to clients who are severely mentally ill.

In further research of the issue Alston, Hunt, and Floyd failed to discover that the contract for these services are held by the Department of Human Services (DHS) with the Federal Government and oversight of DOH-AMHD is solely the responsibility of DHS not DOH.

The ultimate responsibility lays in the hands of Department of Human Services for this lawsuit for two reasons.
(1) The draw down for AMHD is through Department of Human Services who remains contractually responsible for these services.
(2) There is a Memorandum of Agreement between DOH and DHS which sets the parameters for DOH-AMHD services and rules in regulating notice - State Plan Amendment (SPA) & Hawaii Administrative Rules (HAR)

This lawsuit will expose DHS as a payer and holder of applicable contracts with oversight responsibilities for DOH-AMHD. Ultimately the Plaintiffs are suing the State of Hawai'i specifically in this order: DHS (contractually obligated to the Federal Government for oversight), DOH (agreement with DHS), Evercare (coordination and responsibility of managing services for a number of AMHD clients), 'Ohana (coordination and responsibility of managing services for a number of AMHD clients).

Alston, Hunt, and Floyd should have followed the money before filing, let's see what happens next.

Sorry to be so tardy to comment here. Only just found this blog and the subject matter concerns me. Typically, when federal funds come to a state for mental health & substance abuse services, those funds come with comprehensive regulation and requirements. Our adult son is currently a consumer of services in this state and I can tell you he has deteriorated. He is over-medicated so he won't be a bother, frequently hospitalized and in poor health. There is no one accountable or available to answer questions. We are looking to move him out of this state because his life really does depend on it. Hawaii gets a monumental amount of federal money for mental health services. I have been unable, utterly, to get any answers about where that funding actually goes. Clearly, it does not reach the consumers. Thanks all for this information. There isn't very much out there.

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