State Medicaid officials are investigating a private group home that is alleged to have abandoned a disabled man at the University of Kentucky Hospital on Tuesday.
An advocate for Kentuckians who have acquired brain injuries said this week that the alleged incident was indicative of a broader problem with private providers "dumping" disabled people that they are being paid by the state to serve.
Mary Ibold of Gilbertsville said her brother Michael Knue, who received a brain injury in a 2007 motorcycle wreck, was left at the hospital's emergency room by staff from the Somerset group home Community Opportunities Inc.
The group home receives money from the state Medicaid program to care for Knue.
Ibold said there was no notice to the family that he was going to be taken to the University of Kentucky hospital and no apparent medical reason for him to go there.
"They should not have been allowed to do that," Ibold said in an interview Friday.
Justin Smith, executive director of Community Opportunities Inc., did not return a telephone call or respond to an e-mail asking for comments.
Ibold said Community Opportunities staff would not tell her where her brother was during the day on Tuesday, saying other employees had taken him "sightseeing."
Ibold called Kentucky State Police to file a missing persons report when she could not find him. A dispatcher at the London KSP post said Friday that the report was not filed once state police learned that Knue was at a Lexington hospital.
After Ibold called police, she said a group home staff member told her Knue was at UK.
The Cabinet for Health and Family Services, which oversees Medicaid services for brain injured people, "has an open investigation" into Community Opportunities, spokeswoman Gwenda Bond said Thursday.
"We cannot discuss details of the investigation until the findings are complete," Bond said.
However, Ibold provided the Herald-Leader an e-mail dated Wednesday to her from Diane Pratt, the state's Acquired Brain Injury Branch Manager. It said "we are investigating the whole incident" that ended with the group home staff taking Knue to the hospital.
Mary Hass, an advocate with the Brain Injury Alliance of Kentucky, said the case is an example of broader problems with the state's Medicaid program that oversees residential placements for people with acquired brain injuries.
Hass said in an interview Thursday she has received complaints from other families who said private companies paid by the state have "dumped" people with brain injuries, especially those who have particularly difficult behavior.
The state and the providers "must be held accountable for the public dollars being spent to care for our most vulnerable brain injury individuals in Kentucky," said Hass.
"They deserve better than what has been delivered."
For example, Terra Lackey of Campbellsville said her husband, John Lackey, who sustained a severe brain injury in 2005 in a motorcycle wreck, has been terminated from three residential programs and has spent nine months in Kentucky hospitals waiting for placement over the last three years.
She said her husband has complex medical and emotional problems and is currently hospitalized at Lexington's Central Baptist Hospital, where he has been since July.
"State laws should be changed to make sure that private providers accept a certain percentage of difficult patients and they should not be allowed to discharge them inappropriately," Lackey said.
In Knue's case, Ibold said that her brother had lived at Community Opportunities since April 2009. He must use a wheelchair and needs help with eating, dressing and other activities, she said.
Under state regulations, facilities that serve people with brain injuries who need long-term care must give 30 days notice before discharging them, ensure their welfare and continue to provide support until alternative services or another placement is secured.
Ibold said she had been looking for another facility for her brother earlier this year. Then in August, she said, Community Opportunities gave them 30 days notice, saying her brother had exhibited aggressive behavior.
Ibold said the 30 days was up last Sunday, September 12, but the facility did not tell her they were going to discharge him to UK before another place was found.
UK Hospital officials confirmed that Knue was at the hospital on Friday.
Ibold said she expects that Knue will remain at the hospital until the family can find some place for him to live, hopefully in a facility near her home in Western Kentucky.
She said Knue's family members cannot provide in their homes the rehabilitative services he needs.
Hass said officials in the Cabinet for Health and Family Services have told her that the state cannot force any provider to accept someone back into their care if the agency determines that it would be detrimental to the brain injured person or the agency staff.
Marsha Hockensmith, director of Kentucky Protection and Advocacy, said her agency is also reviewing the Knue case.
Hockensmith said that dropping off a brain-injured person at a medical or psychiatric hospital if they don't meet the criteria to be admitted "is certainly not appropriate."
In Kentucky, there are two programs to help people who have acquired brain injuries.
One helps people reenter the community and function independently. The other provides an alternative to institutional care for those who have plateaued in their rehabilitation and require maintenance.
Each program can serve up to 200 individuals, said Bond, the Cabinet spokeswoman.
Of 372 recent cases, the average annual cost per person in the long-term care program was $24,870 and the average cost per client in the rehabilitation program was $72,715.