Task Force To Examine So-Called ‘Custody For Care’ Controversy

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A task force created by state lawmakers will examine whether the Department of Children and Families (DCF) should be prohibited from requiring that parents give up custody of their children in order to access mental health and other services, under legislation signed by the governor. The newly formed panel, which is charged with reporting its recommendations by Feb. 1, 2018, will study whether state statutes should be amended to prohibit DCF from requiring or requesting that a parent or guardian of a youth admitted to DCF on a voluntary basis terminate his or parental rights or transfer custody in order to obtain services. The task force also will study ways of increasing families’ access to voluntary services without making parents relinquish custody of their children. The legislation creating the task force was prompted by recent stories by C-HIT that detailed a practice known as ‘trading custody for care,’ in which parents who cannot meet their children’s severe behavioral health needs in a home setting are subject to “uncared for” petitions that turn their children over to DCF custody.

State Ranks High In Opioid-Related Visits To Hospitals

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In less than eight hours last June, Yale New Haven’s emergency department treated 12 patients who had overdosed on opioids. Three died; nine were saved. With opioids in wide circulation, Dr. Gail D’Onofrio, chief of emergency medicine at the hospital and chair of emergency medicine at Yale School of Medicine, isn’t sure that one-day spike will stand as a record. “To be honest, no, I don’t expect the numbers to get better,” D’Onofrio said. “We’re going to have more treatment options in Connecticut, I think, more safe prescribing — but I don’t know that we’ll see improvements in the numbers of people using.”

D’Onofrio’s concerns are borne out in a recent report by the Agency for Healthcare Research and Quality (AHRQ) that ranks Connecticut the 5th highest among 30 states in the rate of opioid-related emergency department (ED) visits — 254.6 per 100,000 population in 2014, well above national rate of 177.7.

Disparities

Risk Of Death In Connecticut Linked To Where You Live

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Connecticut has seen significant reductions in deaths from breast and colon cancer in the last three decades, but the state exceeds the national mortality rate for uterine cancer and three other cancers, as well as for mental health and substance use disorders. An analysis of data compiled by the Institute for Health Metrics and Evaluation at the University of Washington, published in JAMA, also shows wide disparities between Connecticut counties in death rates from certain cancers and other illnesses. Windham County had the highest mortality rates for seven of 10 cancers identified in the study as having the highest disease burden or responsiveness to screening and treatment, including pancreatic, uterine and lung cancer. Tolland County, meanwhile, had the lowest death rates for five cancers, including breast cancer, while Fairfield County was lowest for four. Similarly, deaths from chronic respiratory diseases in Windham County were nearly double the rate in Fairfield County – 63.13 per 100,000, compared to 34.15.

Task Force Proposed To Study ‘Custody For Care’ Concerns

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The legislature’s Committee on Children has proposed creating a task force to study the state’s so-called “custody for care” controversy, in place of a bill that would have barred the Department of Children and Families (DCF) from pushing parents to relinquish custody when seeking inpatient mental health treatment for their children. If approved, the task force would study the issue of why DCF takes over custody of children in some cases in which parents cannot meet their children’s severe behavioral health needs in a home setting. C-HIT has reported that the state uses “uncared for/specialized needs” petitions to take children into DCF custody in cases where parents argue for inpatient treatment or refuse to take their children home from hospital emergency rooms, for fear they will harm themselves, siblings or others. While DCF officials have said that custody relinquishment is used rarely, judicial department data show the state has used the petitions to take custody of more than 860 children over five years – or an average of three children a week. A bill drafted by state Rep. Rosa Rebimbas, R-Naugatuck, prompted by an October C-HIT story, would have prohibited DCF from “requesting or requiring” that parents relinquish their custodial rights when seeking specialized mental health treatment for their children.

I-Team In-Depth

Pediatric Psychiatric Cases Continue Climbing, Swamping ERs

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The state’s efforts to direct children in mental health crisis away from emergency rooms, to other services, have fallen short, with major hospitals reporting staggering increases in patient visits since 2013: Up 32 percent at Connecticut Children’s Medical Center, and 81 percent at Yale New Haven Hospital. The children’s hospital (CCMC) reported nearly 3,300 visits last year – 275 a month, on average — with the average length of stay increasing to 15 hours from less than 12 in 2013. “I wish I could say we had made a lot of progress, but we haven’t,” said Dr. Steve Rogers, medical director of the emergency department’s (ED’s) behavioral health unit. “Unfortunately, I think it’s only going to keep trending this way.”

Similarly, Yale saw ED visits by children ages 15 and younger rise from fewer than 750 in 2013 to more than 1,350 in 2016 — and the numbers are running even higher this year, said Dr. Claudia Moreno, medical director for psychiatric emergencies in Yale’s children’s emergency department. At times, she said, all ED beds are full, and children wait on hallway gurneys.

Inpatient Mental Health Coverage Rare For State Insurance Plans

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The state’s top insurers were more likely to approve claims for mental health services in 2015 than the year before, but rates of rejection for residential care remained high, a new state report shows. About 6.4 percent of claims for mental health services were rejected by eight top managed care insurers – down from about 8 percent in 2014 – according to an analysis of the 2016 Consumer Report Card on Health Insurance Carriers in Connecticut. At the same time, insurers continued to deny more than one in six requests for residential behavioral health care. And the percentage of managed care plan enrollees who received any inpatient services for mental health was low, with most companies providing such services for fewer than 0.3 percent of all enrollees. The analysis is based on eight companies that reported the same categories of data in 2015 and 2016 to the state Insurance Department, which changed the reporting format across the two years.

Proposed Bill Would End ‘Custody For Care’

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State officials and parent advocates gave different versions Tuesday of how often, and why, the Department of Children and Families (DCF) takes custody of children with severe behavioral health problems – and whether the practice should continue. Advocates, including a group of adoptive parents, told the legislature’s Committee on Children that a proposed bill that would prohibit DCF from “requesting, recommending or requiring” that parents relinquish their custodial rights when seeking mental health treatment for their children is needed to stop a practice known as ‘trading custody for care.’ The bill, drafted by state Rep. Rosa Rebimbas, R-Naugatuck, was prompted by an October C-HIT story that described DCF’s use of “uncared for” custody petitions against parents who could not manage their children at home and insisted on specialized residential care. In testimony Tuesday, DCF Commissioner Joette Katz said the agency resorts to taking over custody only in rare cases in which parents refuse to take their children home from inpatient settings or “will not cooperate” with clinician-recommended in-home or community-based treatment services. “We disagree with the notion that DCF requires parents to completely relinquish custody of their children” to receive suitable behavioral health care, Katz said. She acknowledged that the agency has sharply reduced the number of children it places in residential treatment.

Derby Nurse’s Sentencing Delayed Until July

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A federal judge has agreed to a six-month delay in sentencing a Derby nurse who pleaded guilty to accepting kickbacks in exchange for prescribing a powerful opioid painkiller because she is cooperating in “numerous ongoing criminal investigations,” according to court records. U.S. District Judge Michael Shea approved a Jan. 17 agreement between federal prosecutors and attorneys for Heather Alfonso that delays her sentencing another six months, until July 2017. Alfonso was charged in June 2015 with accepting $83,000 in kickbacks from Insys Therapeutics in exchange for her high prescribing of the drug Subsys. In arguing for the new sentencing delay, the U.S. attorney’s office in Connecticut said Alfonso “continues to cooperate in (investigations in) several federal and state jurisdictions, including the District of Connecticut.” A previous story by C-HIT reported on prior sentencing delays because she was cooperating in an ongoing federal probe.

I-Team In-Depth

New Strain On State Nursing Homes: Keep Patients Out Of Hospitals

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At the Fresh River Healthcare nursing home in East Windsor, the chance that a short-stay patient will end up back in the hospital within 30 days of arriving at the facility is less than eight percent. Meanwhile, 12 miles away at the Greensprings Healthcare and Rehabilitation nursing home in East Hartford, more than a third of patients who came from hospitals will be readmitted in 30 days. The wide swing in nursing home patients’ re-hospitalization rates has a lot to do with the condition patients are in when they are discharged from inpatient stays, as well as the planning that goes into the transition to other care. The federal government has been penalizing hospitals since 2012 for high rates of patients returning within 30 days of discharge. But now, nursing homes (or skilled nursing facilities) also are being held accountable for hospital readmissions.

FBI Reaches Out For Victims Of Subsys Scheme

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In an unusual move, the FBI is reaching out publicly to patients who were prescribed the powerful narcotic medication Subsys, which federal agents allege was improperly dispensed by practitioners across the country, including a nurse in Derby. In a posting on its Victim Assistance Program website, the FBI asks people who were prescribed Subsys between March 2012 and December 2016 to complete a brief questionnaire that will assist in a federal probe of Insys Therapeutics, the company that makes Subsys. The appeal follows the indictments in December of six top executives and managers of Insys on charges they led a nationwide conspiracy to bribe doctors and nurses to prescribe Subsys, which is approved for treating cancer patients suffering episodes of breakthrough pain. In exchange for bribes and kickbacks, the practitioners wrote large numbers of prescriptions for patients, most of whom were not diagnosed with cancer, the indictments allege. One of the practitioners named in the indictments is Heather Alfonso, formerly an advanced practice registered nurse (APRN) at the Comprehensive Pain and Headache Treatment Center in Derby. She has pleaded guilty to accepting kickbacks from Insys through a sham “speakers’ program,” in exchange for prescribing Subsys.