In the judge's hands

Sherry Edwards’ first thought Tuesday morning when she entered the room and found only a judge present, and no one from the opposing side, was that maybe she’d win her case by default—like in traffic court when the cop doesn’t show.

Administrative Law Judge Cristina Phillips broke the bad news: It doesn’t work that way.

Edwards was in a conference room in a county Health and Human Services office in Kearny Mesa, continuing her quest to get the state to pay for out-of-state rehabilitation for her mentally ill, alcoholic and brain-injured brother, Lee Edwards, whose story was detailed in last week’s CityBeat.

Sherry wants to have her brother treated for a year at the Vinland Center in Minnesota, a substance-abuse treatment facility that’s largely geared toward adults with brain injuries. Officials with the San Francisco Medi-Cal Field Office defended their position—to deny Edwards’ request—in writing, arguing, among other things, that substance-abuse treatment doesn’t qualify for Medi-Cal funding and that Lee wouldn’t benefit from rehabilitation. A volunteer lawyer had been working with Edwards on the case but withdrew before the hearing.

Phillips didn’t make a decision after the hearing, which lasted more than an hour (she said most such proceedings take about 15 minutes). She listened to Sherry tell Lee’s life story, accepted about a dozen documents that Sherry provided and asked Sherry a series of questions as they talked. Phillips is required to issue a written decision within 30 days, but an extension is possible.

Judging from her comments and questions, Phillips was most interested in determining as specific an assessment of Lee’s condition as possible, and Sherry handed over documents detailing a schizophrenia diagnosis from four doctors. When Sherry said Lee had improved during a yearlong stay at a locked facility in Lemon Grove, Phillips said that might actually bolster a case the county made years ago—that Lee’s primary problem might have been substance abuse. 

Phillips wanted more information about why Minnesota has a specialized facility like Vinland and California doesn’t, and she wanted to know how many patient referrals Vinland and a similar facility in Oklahoma have had from California.

Sherry commented that the state has spent “hundreds of thousands of dollars” on Lee during the past 14 years while denying him the care that Sherry believes would allow him to become less of a burden on taxpayers. Phillips asked for documentation detailing how the state has spent that money. 

“Nobody says this system isn’t pennywise and pound foolish, “ Phillips commented. “That’s why we have a healthcare crisis in this country.”

But Phillips also warned Sherry that her brother’s age, 58, might be an issue. He’s not likely to become much more of a taxpayer, she said, and sometimes treatment decisions are based on how many productive years a patient has left. But it seemed to be an open issue. “What is the standard for improved quality of life?” she asked rhetorically. “What constitutes rehabilitation?”

Afterward, Sherry was hopeful because she thought the judge’s attitude improved as the hearing progressed. “I’m encouraged,” she said. “She left the door open. I thought that was fair of her.”