State ex rel. Daniel M. v. West Virginia Department of Health & Human Resources

516 S.E.2d 30, 205 W. Va. 16, 1999 W. Va. LEXIS 23
CourtWest Virginia Supreme Court
DecidedMay 14, 1999
DocketNo. 25796
StatusPublished
Cited by1 cases

This text of 516 S.E.2d 30 (State ex rel. Daniel M. v. West Virginia Department of Health & Human Resources) is published on Counsel Stack Legal Research, covering West Virginia Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State ex rel. Daniel M. v. West Virginia Department of Health & Human Resources, 516 S.E.2d 30, 205 W. Va. 16, 1999 W. Va. LEXIS 23 (W. Va. 1999).

Opinion

MAYNARD, Justice:

The petitioner, Daniel M., in this original proceeding in mandamus and/or prohibition seeks to prohibit the respondent, Joan Ohl, Secretary of the Department of Health and Human Resources (DHHR), from withholding funding and to compel DHHR to pay for his placement at Charter Behavioral Health Systems at Piedmont (Piedmont). Because the circuit court properly ordered the out-of-state placement and because it is the duty of DHHR to fund the placement, a writ of mandamus is granted.1

The facts are not in dispute. Daniel M. is a fifteen year old runaway who was adjudged guilty of three counts of felony arson. Daniel insists he drinks alcohol, abuses Ritalin, and uses drugs, including marijuana and acid. He has, nonetheless, twice tested negative for drugs; he contends this is so because he flushed his system with pickle juice and water.

[18]*18On October 8, 1998, Daniel M.’s multidisciplinary team (MDT)2 held a meeting to discuss placement. Believing Daniel would benefit from a therapeutic setting, his probation officer recommended placement at Piedmont, a locked inpatient psychiatric facility located in the State of Virginia.3 Daniel’s mother did not agree Piedmont was the best placement for Daniel due to treatment he received during a previous stay at the facility. His mother told the team she complained to the facility after Daniel called her collect several times late at night; Daniel was then given sleeping pills. Nonetheless, after discussing possible placements at the MDT meeting, the team, noting the objection of DHHR’s case worker, recommended placement at Piedmont. The MDT report gives several reasons for this decision. The report states that Daniel will be able to continue day school at Piedmont once he is released from the facility; Piedmont is located close to Daniel’s family; there is no waiting list; the facility accepts arson charges; and Piedmont is a locked therapeutic facility.

Daniel was adjudged delinquent on October 19, 1998. A dispositional hearing was held on November 2, 1998. Noting DHHR’s objection, the court found “that Piedmont is the only facility available willing to accept a juvenile involved with explosives and/or arson.” The court then ordered that Daniel be placed at Piedmont4 and that “the West Virginia Department of Health and Human Resources shall pay the normal and customary per diem as required by the above named facility!/]” DHHR chose not to appeal the circuit court’s order; however, Daniel M. states that as far as he can determine DHHR has refused to pay for his placement. Therefore, Daniel M. seeks a writ of prohibition/mandamus against Joan Ohl as Secretary of DHHR, prohibiting the department from withholding funding and directing the department to pay for his placement at Piedmont. On January 6, 1999, this Court issued a rule to show cause in prohibition and/or mandamus returnable February 16,1999.

In response to Daniel M.’s petition, DHHR contends that Piedmont is not the appropriate placement for Daniel M. because only nine months prior to the court rendering its order which is at issue here, the facility responded to the juvenile by medicating him and discharging him after one month, at which time he immediately returned to his aggressive and criminal behavior.5 DHHR believes Daniel M. should be placed in a correctional setting rather than a therapeutic environment and in support of this belief states that: (1) federal Medicaid dollars cannot be used to pay for Daniel’s placement, therefore, state funding should also be denied; (2) three psychological evaluations have each concluded that Daniel M. has behavior problems and will not cooperate with or remain in a rehabilitative treatment facility; and (3) since his prior discharge from Piedmont, Daniel’s criminal behavior has escalated. DHHR believes Daniel M. should be provided treatment at Salem, a correctional facility operated by the West Virginia Department of Military Affairs and Public Safety, Division of Juvenile Services.

DHHR expends much time and effort in arguing that since federal Medicaid money cannot be used to assist in funding Daniel M.’s placement at Piedmont, state taxpayer money should not be spent to send Daniel M. to this facility a second time. Federal law mandates the procedure which must be followed before Medicaid will reimburse the State for inpatient services in hospitals, mental hospitals, and intermediate care facilities. DHHR must verify the medical necessity of these services by contracting with a third [19]*19party independent physician review agency. In other words, pursuant to 42 C.F.R. § 456.1(b)(2) (1998),6 Medicaid dollars may only be utilized for payment of inpatient treatment received by juveniles after the independent agency has verified the medical necessity. The State is also required by federal law to have in effect a continuous program “of medical review that includes a medical evaluation of each individual’s need for care in a mental hospital, a plan of care, and, where applicable, a plan of rehabilitation.” 42 C.F.R. § 456.1(b)(3) (1998).

In accordance with federal law, DHHR has contracted with West Virginia Medical Institute (WVMI) to provide the mandated independent reviews. WVMI reviewed Daniel M.’s case. By letter dated November 30, 1998, WVMI informed DHHR that based on a “[pjhysician review of information regarding the current medical needs of the patient indicated above has determined that residential admission and services cannot be authorized.” The letter goes on to explain that this means “that the requested care cannot be certified and may not be reimbursed by the Medicaid program. Further, the recipient cannot be held financially responsible for the services provided.” WVMI recommended “placement in a highly structured group home and intensive outpatient treatment through a local community health center.”

DHHR presents a good argument in terms of funding and this Court is very sensitive to the costs involved in placing juveniles in out-of-state facilities. However, disposition of juvenile delinquents is controlled by W.Va. Code § 49-5-13 and nowhere in that code section do we find a directive stating that a juvenile cannot be placed in a treatment facility if funding under the Medicaid program is denied. DHHR cannot rely on this argument and choose to challenge a circuit court’s order by simply refusing to fund the placement; the proper place to raise the issue is in an appeal to this Court.

There is no question that “ West Virginia Code § 49 — 5—13(b) (Supp.1996) expressly grants authority to circuit courts to make facility-specific decisions concerning juvenile placements.’ Syllabus point 1, State ex rel. W.Va. DHHR v. Frazier, 198 W.Va. 678, 482 S.E.2d 663 (1996).” Syllabus Point 3, State ex rel. Ohl v. Egnor, 201 W.Va. 777, 500 S.E.2d 890 (1997). DHHR does not dispute the circuit court’s authority to designate Daniel M.’s placement but argues the court should have commenced involuntary commitment proceedings pursuant to W.Va.Code § 49-5-13(b)(6) (1997), which states:

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Bluebook (online)
516 S.E.2d 30, 205 W. Va. 16, 1999 W. Va. LEXIS 23, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-ex-rel-daniel-m-v-west-virginia-department-of-health-human-wva-1999.