Health Care Story - 5/21/10

This week, we welcome a guest post from Sheryl Hurst, a 3rd year student at The University of Memphis Cecil C. Humphreys School of Law.  This post is about her experience in working on TennCare appeals.

“Andrew” is a seventeen year-old boy diagnosed with numerous mental health issues, including Autism Spectrum Disorder (atypical autism), Mental Retardation, and Pervasive Developmental Disabilities. Andrew was involuntarily civilly committed by the Juvenile Court of Memphis and Shelby County and placed in the custody of the Tennessee Department of Mental Health and Developmental Disabilities (“DMHDD”). DMHDD placed him at the Middle Tennessee Mental Health Institute’s adolescent center (“MTMHI”). Because MTMHI is an acute care facility designed for short term stays, MTMHI searched for a residential treatment program that was willing to accept Andrew and provide the most appropriate treatment possible for his diagnoses. MTMHI eventually was able to secure a spot for Andrew at the National Deaf Academy (NDA) in Florida.

However, upon acceptance to this residential program, TennCare refused to pay for the services. TennCare deemed such treatment to be “not medically necessary.” In so finding, TennCare asserted that residential treatment was not “safe and effective” because Andrew possessed “active severe suicidal, homicidal, mood or thought disorder problems” that required intensive levels of care. TennCare further stated that Andrew was in “need of more care than residential treatment can safely and effectively provide.” In December of 2009, Andrew appealed TennCare’s decision to deny payment for residential treatment at NDA. On January 29, 2010, The University of Memphis Child and Family Litigation Clinic was appointed as Guardian ad Litem for Andrew.

Andrew’s case was handled by a team of Student Attorneys who in the course of several weeks assembled an extensive list of expert witnesses along with evidence in order to present their case. The Student Attorneys assembled two binders of evidence including medical records and school records, a DVD, and various other materials.  They prepared three expert affidavits and a pre-hearing brief and delivered their entire product to the TennCare attorney in Nashville.  They assembled and prepared four in-person witnesses and two telephone witnesses and prepared for trial.  The hearing was scheduled for April 13, 2010, but an hour before it was set to begin the attorney for TennCare called to settle the case. TennCare authorized payment for residential treatment services.

This case turned out to be a huge victory for the team of Student Attorneys working on the case, as well as for Andrew. It was a great feeling of accomplishment when I learned of the result, and the rush I got is unexplainable.  It was great working to get Andrew the appropriate medical treatment he was entitled to. Providing Andrew with access to the medical treatment he deserves will greatly expand his capability to progress into the adult which he is capable of becoming. Working on the case was a very enjoyable experience and I was extremely pleased with the outcome.

Housed in the University of Memphis, Cecil C. Humphreys School of Law, the Child and Family Litigation Clinic fulfills a critical community service by providing free legal services to under-represented clients, specifically children. Student Attorneys work under close clinical faculty supervision and develop firsthand knowledge about the various ways they can promote social justice and use their law degree in service to society.