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Lawsuit challenges long, medically unnecessary hospital stays for Maryland foster care children

Jessica Boyd stands outside of Northwest Hospital, where her son was hospitalized after three months in a different hospital in Western Maryland. Photo by Kirk McKoy/The Baltimore Banner
Kirk McKoy/The Baltimore Banner
Jessica Boyd stands outside of Northwest Hospital, where her son was hospitalized after three months in a different hospital in Western Maryland.

Over the last several years, hundreds of Maryland children have spent weeks, sometimes months in hospitals for no medical reason. That practice is now the subject of a lawsuit filed Tuesday in federal court. WYPR’s Rachel Baye has been reporting on this issue and joined Ashley Sterner to explain.

Sterner: Rachel, tell us what’s going on here.

Baye: For several years now, children in Maryland’s foster care system who have severe behavioral health needs, in the words of the legal complaint filed Tuesday, have been “warehoused” in hospitals when social workers don’t have anywhere else to put them.

According to the lawsuit, this is a problem the state could solve but has chosen not to.

Mitch Mirviss, a partner at the law firm Venable, is representing the plaintiffs in the case.

Mirviss: We are challenging the lack of sufficient supply of appropriate placements in the community, as well as a lack of appropriate therapeutic clinical interventions, emergency services, wraparound programs, etc., that would allow these children to be placed more readily in the community.

Sterner: Explain how this process works. Exactly how are these children ending up stuck in hospitals?

Baye: I’ll give you an example using one of the plaintiffs in the lawsuit. This plaintiff is a 13-year-old boy identified by the initials T.A, who, according to the legal complaint, has multiple developmental and mental health disabilities. T.A. is in the custody of the Montgomery County Department of Health and Human Services. In mid-November, he ended up at Sheppard Pratt, a psychiatric hospital, after an altercation on a school bus. Less than two weeks later, the medical staff cleared T.A. to be released. But social workers didn’t pick him up, and six months later, he is still there. The lawsuit says T.A. has been accepted to a residential treatment center in Florida and could go as early as next week, depending on when a bed becomes available.

Sterner: So what happens to T.A. in the meantime? What does six months living in a psychiatric hospital look like for kids like T.A.?

Baye: It’s important to remember that facilities like Sheppard Pratt are not set up for long-term care. That’s something that Leslie Seid Margolis, a managing attorney at Disability Rights Maryland, described when we spoke. Disability Rights Maryland is also a plaintiff in the case.

Margolis: While these kids are in the hospital or in the emergency room, they're generally not receiving education. They don't have access to school, they're not allowed to go out. So one of the things we're asking is that they have access to education, and if they can't go to school, that they at least get tutoring.

Baye: Education is not the only thing children miss when they are in the hospital.

One of the plaintiffs in the lawsuit is a 16-year-old boy identified by the initials T.G. He has been at Sheppard Pratt since Aug. 23 and was deemed ready for discharge on Sept. 7. And again, he is still there. T.G. is supposed to receive an annual audiology exam for hearing loss in his right ear, but he has not received it. He also needs glasses, but the hospital won’t allow him to have them out of concern he might misuse them. His social worker has requested goggles for him, but he has not yet received those. And even though his clinical team recommended individual therapy, rather than just group therapy, T.G. is not receiving that therapy.

Sterner: How widespread is this issue? Are there a lot of kids getting stuck in hospitals this way?

Baye: It’s estimated that about 100 kids experience what is known as “hospital overstays” each year, but that’s an estimate. It’s hard to say for sure, in part because not all of the children who end up in this situation are in the foster care system.

I asked the Department of Human Services Tuesday how many are currently stuck in hospitals, but a spokesman did not immediately have an answer.

Sterner: What is the state Department of Human Services saying about this situation?

Baye: The department did not respond to a request for comment about the lawsuit.

However, this is not a new issue, and over the years, several department leaders have described their efforts to solve it. Those efforts usually include increasing the number of beds available at residential treatment centers.

Brian Mroz, acting deputy secretary of operations at the Maryland Department of Health, heads an interagency workgroup that reviews the cases of children who are particularly hard to place. He spoke at a state legislative hearing in February.

Mroz: One of the first items that we identified through this collaboration was a need for more support for residential treatment centers. MDH provided additional funding for these residential treatment centers to support and stabilize the industry and to increase our ability to place more complex cases.

Baye: There is a shortage of residential treatment center beds, not just in Maryland but nationally, so there are long waitlists for those beds.

But the lawyers behind Tuesday’s lawsuit say the state is relying too much on residential treatment centers when there are other less-restrictive treatment options that would be more appropriate in many cases.

This is Leslie Seid Margolis, from Disability Rights Maryland.

Seid Margolis: It's that narrowness of vision that these are children who need that restrictive level of care and the lack of creativity and thinking about how you can create wraparound services and create intensive services in less restrictive settings that is what I think is so frustrating for me.

Baye: She said there are models in other states that Maryland could follow. Many of those models are expensive, though, and it becomes a question of political will.

Sterner: And I guess the question of whether there is enough political will to make changes is one that still has to be answered. Rachel, thank you so much for joining us this morning.

Baye: My pleasure.

Rachel Baye is a senior reporter and editor in WYPR's newsroom.
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