As a result, they were repeatedly institutionalized at psychiatric facilities, violating the District’s obligations to provide the least restrictive care possible under Medicaid and the Americans With Disabilities Act, according to the lawsuit.
One of the two children, a 14-year-old girl identified in the complaint as “M.J.,” was hospitalized at least nine times in four years because she did not receive adequate outreach while living at home, according to the lawsuit, which alleges that her situation probably reflects a widespread failure affecting hundreds of other D.C. children who are receiving care through the government.
Those children “suffer dramatically curtailed life opportunities due to Defendants’ continuing, long-standing failure to satisfy federal laws requiring the District of Columbia to provide medically necessary services to prevent unnecessary institutionalization,” the complaint states.
A spokeswoman for D.C. Mayor Muriel E. Bowser (D) declined to comment, citing the pending litigation. Wayne Turnage, director of the D.C. Department of Health Care Finance — which administers the District’s Medicaid program — declined to comment. A spokeswoman for the D.C. Department of Behavioral Health did not respond to a request for comment.
A spokesman for D.C. Attorney General Karl A. Racine (D), whose office defends the District in lawsuits, declined to comment.
The District’s policies are at odds with the prevailing national paradigm of offering mental-health services to children without disrupting their lives by whisking them away from home and school to warehouses for the mentally ill, said Lewis Bossing, a senior staff attorney at the Bazelon Center for Mental Health Law and one of the lawyers representing the child plaintiffs in the lawsuit.
“We’re talking about services that the federal government has said jurisdictions must provide, if they’re necessary,” Bossing said.
“Once you are separated and once you are institutionalized — from your family and from your community — the outcomes for those kids are worse,” he added. “You are separated from all the natural supports in your life, and you are sent away to an institution where you are only seeing and only interacting with other kids with mental-health disabilities.”
The complaint does not offer a precise number of children who might be suffering harm from a lack of effective outpatient services, but it notes that more than 300 Medicaid-eligible minors with a “serious emotional disturbance” were admitted to psychiatric treatment facilities during the 2017 fiscal year.
“Most of these admissions could have been avoided had the children timely received intensive community-based services,” the complaint said.
Bossing said those services, when provided in other cities and states, vary by case but frequently involve mentors or counselors — often working with nonprofit groups — who can be in regular contact with children and their families and are on call to deal with any problems.
The plaintiff M.J. has been diagnosed with conditions including anxiety, depression, post-traumatic stress disorder and attention-deficit/hyperactivity disorder, according to the lawsuit. She spent a night in custody at the Department of Youth Rehabilitation Services after she was arrested and accused of assaulting her mother in 2016, according to the complaint, and has repeatedly been suspended from school.
The lawsuit said that M.J. received some at-home services over short periods but that they were insufficient.
The second plaintiff, a 17-year-old girl identified as “L.R.,” has been diagnosed with bipolar disorder, post-traumatic stress disorder and attention-deficit/
hyperactivity disorder, the complaint said, adding that she has been hospitalized at least five times since 2011.
The lawsuit said that although “L.R. and her father are interested in receiving” intensive mental health services, “the District has not worked with them to arrange for her to receive these services while she has lived at home.”
Disability Rights D.C. at University Legal Services and the National Center for Youth Law are also involved in the lawsuit on behalf of the plaintiffs.