1
1
2
3 SENATE/HOUSE OF REPRESENTATIVES
4 THE 21ST LEGISLATURE
5 INTERIM OF 2001
6
7
8
9 JOINT SENATE-HOUSE INVESTIGATIVE COMMITTEE HEARING
10 OCTOBER 3, 2001
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12
13
14 Taken at the State Capitol, 415 South Beretania,
15 Conference Room 325, Honolulu, Hawaii, commencing at
16 9:08 a.m. on Wednesday, October 3, 2001.
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18
19
20
21 BEFORE: SHARON L. ROSS, CSR No. 432
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25
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1 APPEARANCES:
2
3 Senate-House Investigative Committee:
4 Co-Chair Senator Colleen Hanabusa
5 Co-Chair Representative Scott Saiki
6 Vice-Chair Senator Russell Kokubun
7 Vice-Chair Representative Blake Oshiro
8 Senator Jan Yagi Buen
9 Representative Ken Ito
10 Representative Bertha Kawakami
11 Representative Bertha Leong
12 Representative Barbara Marumoto
13 Senator David Matsuura
14 Senator Norman Sakamoto
15
16 Also Present:
17 Special Counsel James Kawashima
18 Ms. Margaret Pereira
19 Dr. Kenneth Charles Gardiner
20 Mr. Michael Stewart
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25
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1 I N D E X
2
3 WITNESS: MARGARET PEREIRA
4 EXAMINATION BY: PAGE
5 SPECIAL COUNSEL KAWASHIMA............. 7
6 VICE-CHAIR REPRESENTATIVE OSHIRO...... 39
7 VICE-CHAIR SENATOR KOKUBUN............ 52
8 REPRESENTATIVE ITO.................... 57
9 REPRESENTATIVE KAWAKAMI............... 65
10 SENATOR MATSUURA...................... 76
11 REPRESENTATIVE LEONG.................. 85
12 SENATOR SAKAMOTO...................... 91
13 REPRESENTATIVE MARUMOTO............... 97
14 SENATOR BUEN.......................... 103
15 CO-CHAIR SENATOR HANABUSA............. 106
16 CO-CHAIR REPRESENTATIVE SAIKI......... 127
17
18 WITNESS: DR. KENNETH CHARLES GARDINER
19 EXAMINATION BY:
20 SPECIAL COUNSEL KAWASHIMA............. 139
21 VICE-CHAIR REPRESENTATIVE OSHIRO...... 173
22 SENATOR BUEN.......................... 183
23 REPRESENTATIVE ITO.................... 184
24 REPRESENTATIVE KAWAKAMI............... 186
25 REPRESENTATIVE LEONG.................. 192
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1 I N D E X, (Continued)
2
3 WITNESS: DR. KENNETH CHARLES GARDINER
4 EXAMINATION BY: PAGE
5 CO-CHAIR REPRESENTATIVE SAIKI......... 195
6 CO-CHAIR SENATOR HANABUSA............. 201
7
8 WITNESS: MICHAEL STEWART
9 EXAMINATION BY:
10 SPECIAL COUNSEL KAWASHIMA............. 215
11 VICE-CHAIR REPRESENTATIVE OSHIRO...... 246
12 VICE-CHAIR SENATOR KOKUBUN............ 253
13 REPRESENTATIVE ITO.................... 258
14 SENATOR BUEN.......................... 261
15 SENATOR KAWAKAMI...................... 267
16 SENATOR SAKAMOTO...................... 276
17 REPRESENTATIVE LEONG.................. 286
18 REPRESENTATIVE MARUMOTO............... 289
19 CO-CHAIR SENATOR HANABUSA............. 290
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25
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1 PROCEEDINGS
2 CO-CHAIR REPRESENTATIVE SAIKI: Good morning.
3 We would like to call our Joint Investigative Committee
4 to investigate the State's efforts to comply with the
5 Felix Consent Decree to order. We will begin with the
6 roll call.
7 CO-CHAIR SENATOR HANABUSA: Co-Chair Saiki?
8 CO-CHAIR REPRESENTATIVE SAIKI: Present.
9 CO-CHAIR SENATOR HANABUSA: Vice-Chair
10 Kokubun?
11 VICE-CHAIR SENATOR KOKUBUN: Present.
12 CO-CHAIR SENATOR HANABUSA: Vice-Chair
13 Oshiro?
14 VICE-CHAIR REPRESENTATIVE OSHIRO: Here.
15 CO-CHAIR SENATOR HANABUSA: Senator Buen is
16 excused. Representative Ito?
17 REPRESENTATIVE ITO: Present.
18 CO-CHAIR SENATOR HANABUSA: Representative
19 Kawakami?
20 REPRESENTATIVE KAWAKAMI: Present.
21 CO-CHAIR SENATOR HANABUSA: Representative
22 Leong?
23 REPRESENTATIVE LEONG: Present.
24 CO-CHAIR SENATOR HANABUSA: Representative
25 Matsu -- Marumoto?
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1 REPRESENTATIVE MARUMOTO: Present.
2 CO-CHAIR SENATOR HANABUSA: Senator Matsuura
3 is excused. Senator Sakamoto is excused. Senator Slom
4 is excused. Co-Chair Hanabusa is here.
5 Co-Chair Saiki, we have a quorum.
6 CO-CHAIR REPRESENTATIVE SAIKI: Thank you
7 very much. Members, first of all, we would like to note
8 that our -- the first witness that was scheduled to
9 appear this morning was Dr. Judith Schrag. With your
10 concurrence, we would like to move this item to the end
11 of our agenda this -- today; and we would like to begin
12 with our -- with Mrs. Margaret Pereira and -- if you'll
13 deliver the oath.
14 CO-CHAIR SENATOR HANABUSA: Mrs. Pereira --
15 MARGARET PEREIRA: Uh-huh.
16 CO-CHAIR SENATOR HANABUSA: -- do you
17 solemnly swear or affirm that the testimony you are
18 about to give will be the truth, the whole truth, and
19 nothing but the truth?
20 MARGARET PEREIRA: Yes.
21 CO-CHAIR SENATOR HANABUSA: Mrs. Pereira will
22 be questioned by the Committee's legal counsel,
23 Mr. Kawashima.
24 SPECIAL COUNSEL KAWASHIMA: Thank you, Madam
25 Chair.
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1 EXAMINATION
2 BY SPECIAL COUNSEL KAWASHIMA:
3 Q. Please state your name and where you live for
4 the record, please.
5 A. Margaret Pereira, Kaneohe, Hawaii.
6 Q. Ma'am -- Ms. Pereira -- is it Ms. Pereira?
7 A. Mrs.
8 Q. Mrs. Pereira, will you tell us -- give us
9 some background as to your work experience?
10 A. I've had about ten years starting in
11 California with a safe house for abused women, then in
12 Hawaii as a residential counselor for Child and Family
13 Service and project coordinator for the team line,
14 Suicide and Crisis Center on the crisis team and --
15 let's see. At Susannah Wesley I was a therapeutic aide,
16 case manager -- intensive case manager, and family
17 resource specialist with the MST Continuum. And I was
18 the project coordinator under contract from PREL working
19 at Waiahole Elementary School.
20 CO-CHAIR REPRESENTATIVE SAIKI: Excuse me,
21 Mrs. Pereira. Would you please pull the microphone up?
22 We can't really hear. Thank you.
23 Q. (BY REPRESENTATIVE KAWAKAMI) All right. Let
24 me ask you some questions, ma'am, about this -- the
25 information you just gave us. You mentioned being an
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1 intensive care manager --
2 A. Case manager.
3 Q. Case manager? And for whom was that?
4 A. Susannah Wesley Community Center.
5 Q. During what period of time did you hold that
6 position?
7 A. From October, '99 -- no, '95 until August --
8 September, '99.
9 Q. All right.
10 A. No, no, October, '95 to September, '99.
11 Q. All right. Now, after 1999, who did you work
12 for?
13 A. Under a PREL grant with a key project in
14 Kahalui.
15 Q. Okay. That was the PREL employment you
16 mentioned earlier?
17 A. Right.
18 Q. And that was for how long?
19 A. Six months.
20 Q. All right. And then after that, '99, 2000,
21 around there --
22 A. 2000.
23 Q. -- where did you go then?
24 A. To the MST Continuum as a resource
25 specialist. Actually it was under Hawaii Families as
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1 Allies. The MST Continuum contracted Hawaii Families as
2 Allies for a family resource specialist.
3 Q. All right. And that was -- in what period
4 did you remain in that position, ma'am?
5 A. Until the end of this year, August 31st.
6 Q. All right. So, over a year -- one year you
7 were with that project, right?
8 A. Right.
9 Q. Now, let me ask you then about this last
10 employment you had with the MST Continuum research
11 project.
12 A. Uh-huh.
13 Q. Now, you say you worked there for a year and
14 a month?
15 A. Right.
16 Q. And you were a family research specialist?
17 A. Right.
18 Q. What were your duties as a family research
19 specialist?
20 A. I was told, as a family research specialist
21 when we were hired, that we would advocate for the
22 families in making sure they were getting services that
23 they needed; but it sort of overflowed into case
24 management and, I think, somewhat of the therapist
25 position.
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1 I have the -- oh, what do you call it? I
2 have the job descriptions here; and I brought it to
3 their attention that a lot of the people were
4 inexperienced that they hired. So, I think I was
5 covering a lot of the case management and part of the
6 therapist's position.
7 Q. In other words, you were doing more than your
8 job called for?
9 A. Yes, and they acknowledged it.
10 Q. All right. We'll get back to that, ma'am.
11 A. Okay.
12 Q. Who was your supervisor there at MST
13 Continuum?
14 A. Clinical supervisor was John Donkervoet.
15 Q. And you say "clinical supervisor." Was there
16 another aspect of supervision provided by someone else?
17 A. We had a medical director, Dr. Terry Lee, and
18 the administrator was Carol Matsuoka.
19 Q. Was there another group involved? I recall
20 the name Hawaii Familes as Allies.
21 A. That was administrative for -- actually, they
22 sort of just wrote the paychecks.
23 Q. I see. Do you understand -- do you know what
24 type of organization that was?
25 A. Hawaii Familes as Allies?
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1 Q. Yes.
2 A. I guess it was -- I'm not --
3 Q. If you don't -- don't guess, ma'am.
4 A. Yeah.
5 Q. Now, you testified, though, that your
6 clinical supervisor was John Donkervoet?
7 A. Yes.
8 Q. Now, was he the overall director of the
9 program also?
10 A. Director of the whole -- in the beginning, we
11 were told he was the overall; and that was the role he
12 took because we took everything to John.
13 Q. All right. And "overall" meaning over all
14 for the MST Continuum?
15 A. Right.
16 Q. And that Continuum, ma'am, was a research
17 project, was it not?
18 A. Right.
19 Q. And it was funded by the department -- Hawaii
20 State Department of Health?
21 A. Yes, that's what we were told.
22 Q. And, in fact, Tina Donkervoet was the head of
23 the child and adolescent mental health division of the
24 state mental -- Department of Health when the MST
25 contract was given to John Donkervoet; is that correct?
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1 A. Yes.
2 Q. And do you know if there is any relationship
3 between Mr. Donkervoet and Mrs. Donkervoet, Tina and
4 John?
5 A. Husband and wife.
6 Q. Now, my understanding, ma'am, is that this
7 MST Continuum was a test run or a pilot project for the
8 entire state; is that correct?
9 A. Right, yes.
10 Q. And it was to be used with Felix children?
11 A. Yes.
12 Q. And the research project had a MST group and
13 a comparison non-MST group; is that correct?
14 A. Yes.
15 Q. In other words, when you do a research
16 project, sometimes you want to have a group that's not
17 involved with the actual research that you're doing to
18 see -- to compare later on whether or not the project is
19 effective or not?
20 A. Right.
21 Q. Is that a fair statement?
22 A. Uh-huh.
23 Q. And that's your understanding as to why they
24 had this, what we'll call, comparison group?
25 A. Right, MST and usual services.
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1 Q. Usual services? We'll use that word.
2 A. That's the word we were told.
3 Q. All right. Now, is it your understanding,
4 though, ma'am, that as far as the two groups, the MST
5 group on the one hand and the usual services or non-MST
6 group on the other, that the Felix children that were in
7 that group had -- were to be placed there randomly?
8 A. Yes.
9 Q. In other words, not specifically selected for
10 each one; otherwise, you would not have a fair
11 comparison, right?
12 A. Right.
13 Q. Okay. So, do you know or do you have an
14 understanding as to whether or not children were, in
15 fact, specifically placed in a particular group as
16 opposed to being randomly placed?
17 A. I can say what I was told and what I --
18 Q. Well, tell us that first.
19 A. Okay. That sometimes when the re -- the
20 recruiter, which was generally the crisis case manager,
21 as we called them, would go out and recruit the
22 families, sometimes they were told to switch the
23 envelopes.
24 Q. To switch the envelopes?
25 A. Yes.
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1 Q. What do you mean by that?
2 A. There's envelopes that they show the families
3 that would show -- if they decided to stay in and be
4 part of the research, the envelope would either say
5 "usual services" or "MST"; and they knew ahead of time,
6 the recruiters, what -- if the person would be getting
7 usual services or MST. And I was told that they were
8 told to switch the envelopes sometimes.
9 Q. Sometimes. Were you told how often that
10 happened?
11 A. No.
12 Q. And were you told why that was happening?
13 A. Yes, so that it would show that MS -- usual
14 services was taking up a little more money than MST was.
15 Q. I see. Basically, then, to make MST look
16 better?
17 A. Right.
18 Q. Now, were there other problems, ma'am, as to
19 the way the MST research project was run?
20 A. Well, I think I brought my concerns from the
21 beginning about the inexperience of the people that were
22 hired, the therapists and people that they were bringing
23 over from the Mainland. And I said they weren't
24 culturally, you know, competent or sensitive to the
25 culture here and they lacked the experience to know the
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1 process of how to go through the Felix Consent Decree
2 and they knew none of the process of, say, the IEPs or
3 transitioning children or -- they were -- they -- some
4 of them didn't even understand what the DSM-IV was, you
5 know, which surprised --
6 Q. DSM-IV?
7 A. Which is a book with all the diagnoses in it.
8 When it was brought up, they didn't know; and I somewhat
9 felt bad for some of the therapists. I mean, it was
10 like one, two, three, go; and they didn't even have a
11 clue as to how to begin family therapy.
12 Q. Now, just to be sure, ma'am, we're talking
13 about the same thing, DSM Roman numeral IV --
14 A. Right.
15 Q. -- that's used in treatment of --
16 A. Diagnosis.
17 Q. -- diagnoses of -- by psychiatrists and
18 psychologists --
19 A. Right.
20 Q. -- and people in that area; is that correct?
21 A. Right. And some of the therapists, they were
22 new to the island. They were kind of hesitant in going
23 to some areas in Hawaii where most of the kids -- our
24 families are, being in the lower end.
25 Q. All right. Let me hold off on that for a few
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1 minutes, ma'am. What kind of problems, if any, did you
2 notice in terms of documentation?
3 A. Well, in the beginning, we were told --
4 everyone was told, you know, there's no paperwork
5 because we didn't have to do service authorizations.
6 There was minor documentation, and then I found that the
7 case managers weren't doing any documentation.
8 And I -- until today, I don't think there is
9 anything. When I went -- you know, when I would go
10 through the files, there's nothing to show they even
11 went out to the home or did anything; and some of the
12 therapists weren't clear on what SOAPing was and, you
13 know, they had to do some training.
14 Q. Okay. Now -- I'm sorry.
15 A. I'm sorry.
16 Q. Let me -- I didn't mean to cut you off, but
17 I -- before I forget to ask you, you used the term
18 "service authorizations." What is that?
19 A. In usual service, if a client wants services,
20 they have to go through a care coordinator and get
21 service authorizations units to show them how many hours
22 they're going to -- they've been authorized to spend
23 with the client and the family; and we didn't get that.
24 Q. This -- what it appears, ma'am, is that the
25 service authorization is just another form of
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1 accountability?
2 A. Right.
3 Q. And there was no -- there were no service
4 authorizations --
5 A. No.
6 Q. -- that were filled out, to your knowledge?
7 A. No, you don't -- for residential, we ended up
8 doing service auts for residential; but they didn't
9 think we would need that because the Continuum said that
10 we would be -- our goal was not to put kids in
11 residential.
12 Q. The goal was to keep them in MST?
13 A. Right, to keep them at home in the community,
14 in the environment.
15 Q. You used the term, also, scoping. What is
16 that?
17 A. SOAPing. It's how they write out their
18 progress notes.
19 Q. Oh, I see. I see. Subjective, objective --
20 A. Subjective, objective --
21 Q. Right. And you also say that the case
22 managers did not keep a chart --
23 A. No.
24 Q. -- of what they were doing --
25 A. No.
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1 Q. -- with the children?
2 A. No.
3 Q. So, how would one know what type of
4 treatment -- without using names now --
5 A. Right.
6 Q. -- of the children, how would one know what
7 kind of care was being given, whether it was effective
8 or helping or not? How would one know that?
9 A. By word of mouth.
10 Q. You mentioned, ma'am, Mainland therapists?
11 A. Uh-huh, right.
12 Q. Explain to us a little bit more what you mean
13 by that.
14 A. Well, when they hired -- I think it was two
15 or three therapists, maybe four. When they came over,
16 they -- I asked them how they knew about MST because I
17 had recommended some people that were on the island here
18 and they didn't get the position; and they were hired --
19 they said they were hired over the Internet.
20 I mean, they looked over the Internet, they
21 made a call, and they got their interview over the
22 phone. And I said, "But you come here with not knowing
23 anything about our culture and our process here is going
24 to take a long time to train and even see if you're fit
25 for a lot of the families here."
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1 Q. Now, these people you're talking about who,
2 according to them, got hired over the Internet --
3 A. Uh-huh.
4 Q. -- what range are we talking about in terms
5 of numbers that you observed?
6 A. Oh, I know about four.
7 Q. Four. And who -- do you know -- who hired
8 them, if you know? If you don't, please, don't guess.
9 A. Well, this is what they told me. They said
10 John Donkervoet.
11 Q. Mr. Donkervoet?
12 A. Uh-huh.
13 Q. And was it your understanding that people of
14 that experience and skills and education that were being
15 brought down from the Mainland -- that there were no
16 people or -- well, there were no professionals in Hawaii
17 who could provide the same services?
18 A. I knew there were professionals in Hawaii
19 that could provide the same services because I referred
20 them in the beginning. Towards the middle, I didn't
21 anymore.
22 Q. Why not?
23 A. Because I knew where the research was going.
24 Q. Now, the people that came down from the
25 Mainland then, ma'am --
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1 A. Right.
2 Q. -- am I to understand every -- all their
3 expenses were paid to move here and work permanently?
4 A. I don't know about their expenses.
5 Q. But these were permanent hires, not part-time
6 or temporary people?
7 A. No, they were permanent.
8 Q. Okay. Now, did you raise complaints about
9 these subjects or these problems that you've testified
10 about?
11 A. Constantly.
12 Q. To whom?
13 A. John Donkervoet; Terry Lee; my supervisor,
14 which was Sharon Nobriga and Vicky Followell; and the
15 South Carolina consultants, Dr. Philippe Cunningham and
16 Dr. Jeff Randall.
17 Q. South Carolina consultants?
18 A. Right.
19 Q. Do you know why they were here?
20 A. Why they --
21 Q. Why they were brought to Hawaii, South
22 Carolina people?
23 A. They were the consultants for the MST team.
24 That's all I know.
25 Q. Oh, I see.
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1 A. We repeat -- we reported every Tuesday and
2 went over the cases with them.
3 Q. And did -- you actually talked to this
4 Dr. Cunningham --
5 A. Uh-huh.
6 Q. -- and what was the other person's name?
7 A. Jeff Randall.
8 Q. Crandall?
9 A. Randall, R-A-N.
10 Q. And what did you do -- what did you -- well,
11 strike that.
12 A. What did I --
13 Q. You complained about these problems, you just
14 testified?
15 A. There was a lot of problems. I said there's
16 no accountability and I said people were working that --
17 I mean, short of saying that they were working and they
18 weren't working, they were saying that they were seeing
19 their clients and they weren't seeing their clients; and
20 this would be reported by the parents that would call
21 me.
22 And a lot of them were just -- and I said I
23 thought the MST model was that they would be seeing the
24 client, you know, at least, on the minimum, three to
25 four hours a week. I mean, they're saying five; but I
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1 thought if it's intensive, it would be more but -- and I
2 knew they weren't -- they weren't doing it.
3 And I said they were marking on their time
4 sheets, which they showed me and they told me, "on
5 call," which you get paid more when you're on standby.
6 And I know they weren't doing -- they weren't doing it.
7 Q. All right.
8 A. They were at home.
9 Q. We'll get to that, ma'am. What kind of
10 response did you get from these people from South
11 Carolina?
12 A. They said to take it to Terry Lee, which I
13 did; and I took it to my supervisors, who also took it
14 to Terry Lee. And when I asked them what their report
15 was after they said that -- they took it to Terry -- I
16 said, because, to me, it constitutes fraud, you know,
17 some -- they're documenting that they're seeing someone
18 and they're not. And I said, you know, I was tired of
19 getting complaints from the parents.
20 And she -- although my supervisors told me
21 that they told Terry, you know, that constitutes fraud;
22 and he said, "Yeah, he knows that but they're trying to
23 clean it up."
24 Q. Who is Terry Lee?
25 A. He is our medical director for MST.
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1 Q. He's a physician, MD physician?
2 A. Psychiatrist.
3 Q. Dr. Terry Lee?
4 A. Right.
5 Q. You also took it, you say, to Ms. Nobriga?
6 A. Right.
7 Q. And also took it to Mr. Donkervoet?
8 A. No.
9 Q. You did not?
10 A. No.
11 Q. Oh, I'm sorry. Do you know if anyone did,
12 took those concerns you expressed to them up to the
13 level of Mr. Donkervoet?
14 A. No. I was asked by South Carolina, when I
15 went as far as that, to take --
16 Q. Consultants?
17 A. Right, to the consultants. I was asked --
18 they said, "Well, you know, you could take it to Tina."
19 And I thought, well, you know, I'm talking
20 about John and Terry and, you know, where would I go
21 with this? You know, where would I go? I have no....
22 Q. Now, what happened to this MST Continuum
23 research project, ma'am?
24 A. It closed -- well, partially closed on
25 August 20th. We were called in and said they were
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1 closing down.
2 Q. August 20th of this year?
3 A. Of this year.
4 Q. A little over a month ago?
5 A. Uh-huh.
6 Q. Are you aware, ma'am, as to the two groups
7 within this MST Continuum research project, one being
8 the MST group and the other being the non-MST group or,
9 as you call it, usual services --
10 A. Uh-huh.
11 Q. -- group, how they compared at the end of
12 that point in time when the project was terminated?
13 A. Well, I can only go by what -- when I talked
14 to one of the researchers and they said the results were
15 the same. If you have a dedicated therapist and --
16 dedicated honest therapist who followed through with the
17 family, then, you would get the same results. If you
18 empowered the family to know the system and to cooperate
19 with the plan, then, you would get the same results.
20 Q. Now, there were a number of children that
21 were part of that MST Continuum project, right?
22 A. Yes.
23 Q. When the project terminated, what happened to
24 them?
25 A. Well, on the 20th when they told us to start
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1 transitioning -- and I can only say what they told me
2 when we went into a separate meeting with Terry Lee and
3 my supervisors. I was told to start transitioning -- I
4 had two-and-a-half days.
5 Q. Two-and-a-half days?
6 A. Yes. And that I am to go out only with the
7 consultant and the therapist, not to go alone, not to
8 have any contact alone with the families and, after
9 those two-and-a-half days, not to contact the families,
10 not to talk to them, see them, or have anything to do
11 with them.
12 Q. What if they called you and had some
13 concerns? What were you supposed to do?
14 A. I was supposed to give back my cell phone
15 within that time. It's a work cell phone.
16 Q. So that these families would have no one to
17 call?
18 A. They would call maybe the therapist, but not
19 me, if the therapist was still on.
20 Q. I see.
21 A. Right.
22 Q. I see. But you could not communicate with
23 them any longer --
24 A. Right.
25 Q. -- because they took away your phone?
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1 A. Right.
2 Q. Did they, in fact, take away your phone?
3 A. Yes, they made me give it back and --
4 Q. Do you know how much money was spent on this
5 MST project?
6 A. No, I have no idea.
7 Q. Just based on your knowledge and experience
8 and what you did within the project itself, ma'am, do
9 you feel that money was wasted on this project?
10 A. Yes.
11 Q. Now, moving to another area, you mentioned
12 you worked with the Susannah Wesley Center --
13 A. Uh-huh.
14 Q. -- is that correct?
15 A. Yes.
16 Q. For how many years?
17 A. Four years.
18 Q. And you -- I think you testified earlier you
19 were an intensive care coordinator?
20 A. Case manager.
21 Q. And what kind of duties and responsibilities
22 did you have, ma'am, as an intensive case manager?
23 A. I think it's the same as a care coord -- what
24 they call a care coordinator today, which is, you know,
25 coordinating services and, you know, doing referrals and
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1 efficacy linkages and doing supportive counseling.
2 Q. I forgot to ask you, ma'am. Did you, in
3 fact, go to these parents and tell them that the MST
4 project was going to be terminated?
5 A. Yes.
6 Q. And what types of response did you get --
7 without uses names now -- for now, what types of
8 response did you get from these families?
9 A. They wanted to know if it was legal because
10 they said they were promised two years. And I said, "I
11 don't know." You know, I couldn't tell them.
12 They wanted to know if I would still be
13 advocating for them because I still had meetings to go
14 to and IEPs; and, you know, we still had a lot of
15 unfinished business to do. And they were extremely
16 upset. They didn't want to tell their children because
17 the children -- you know, they were promised a continuum
18 kind of service.
19 And I did answer that I would continue. I
20 mean, I wouldn't be getting paid; but I would continue
21 because, to me, I was a free agent then and no one could
22 actually dictate what I can and cannot do but....
23 Q. I see. But you couldn't --
24 A. They were very upset, extremely upset. And
25 some were -- they were brought to tears; and they just
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1 wanted to know who they -- do they call, do they need an
2 attorney or -- and I said, "I don't know. I don't
3 know."
4 Q. Did you communicate these issues, ma'am, the
5 fact that some parents were upset to the point of tears,
6 to your supervisors?
7 A. Well, our consultant was with us; and he saw
8 it.
9 Q. Did he say anything?
10 A. He just says, "I hear you and you have a
11 right to be upset."
12 Q. Did he tell them why they had a right to be
13 upset?
14 A. He -- they gave out a press release also that
15 I have here and -- yeah, he told them they have a right
16 to be upset and maybe they should call division.
17 Q. All right. And -- but as far as them being
18 able to contact you after that, they wouldn't be able to
19 because your phone was taken away from you?
20 A. Right.
21 Q. Now, let me get back, ma'am. I got
22 sidetracked there. Back to this work you did as an
23 intensive case manager -- and I guess they're called --
24 they call them now an intensive care coordinator --
25 A. Uh-huh.
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1 Q. -- at the Susannah Wesley Center, did that
2 center provide care to Felix children?
3 A. Yes.
4 Q. And did this Susannah Wesley Center partner
5 with the Leeward Family Guidance Center to provide those
6 types of services?
7 A. Yes. In '90 -- I think it was from '95 to
8 '97 we were on a federal grant to the Ohana Project.
9 Q. And --
10 A. There was no billing at that time.
11 Q. Well, let me ask you this, ma'am. While you
12 were there with the project -- I should say with the
13 center --
14 A. Uh-huh.
15 Q. -- partnering with the Leeward Family
16 Guidance Center --
17 A. Uh-huh.
18 Q. -- did you observe or become familiar with
19 how services were billed?
20 A. They didn't bill in the beginning, the first
21 two years.
22 Q. When you say "didn't bill," what --
23 A. There was no billing in place at that time.
24 Q. When you say "billing," though, billing to
25 whom?
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1 A. Billing to division, CAMHD.
2 Q. C-A -- C-A-M-H-D?
3 A. Right.
4 Q. All right. Do you know why there were no --
5 nothing was being billed?
6 A. I believe because we were under the Ohana
7 Project under federal grant, and that took care of the
8 services.
9 Q. There came a time, though, that services
10 were, in fact, billed, though --
11 A. Right.
12 Q. -- while you were there?
13 A. Right.
14 Q. And were there situations, ma'am, of which
15 you were aware where providers were overbilling for
16 services rendered?
17 A. Yes.
18 Q. Give me an example. "Providers" meaning
19 people providing services to Felix children, right?
20 A. Uh-huh.
21 Q. And "services" meaning -- it could be a
22 number of things that they would provide that would
23 be -- would consist of a service, right?
24 A. Right.
25 Q. Give us examples -- give the Committee some
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1 examples of these services and how you observed them to
2 be overbilled.
3 A. Well, it -- when we started billing, which
4 was in '97, September of '97, we were told we had to put
5 in a minimum of 25 hours a week of billable hours and to
6 be creative in our billing.
7 That means walk slow to the cabinets where
8 the files are because that's billable, to actually go
9 and pick up the file and bring it back to your desk.
10 And that should be at least 15 minutes they said, you
11 know; but --
12 Q. Billing -- when you say 15 minutes, though,
13 how would you bill 15 minutes?
14 A. Well, it's part of your collateral contact
15 you would call it.
16 Q. No. I mean --
17 A. Because you're working with the -- you bill
18 it under what -- a code.
19 Q. I see. But 15 minutes -- how does one bill
20 15 minutes in terms of that unit of time?
21 A. A unit -- well, the units have changed. In
22 '97, like, one unit was an hour. I mean, a unit could
23 be by hours. One unit was an hour; but since then, it's
24 changed.
25 Q. To what?
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1 A. Like, .15, I think, or -- I forget.
2 Q. In other words, by --
3 A. They broke it down in quarters.
4 Q. They broke the hour down into minutes --
5 A. Right.
6 Q. -- in other words.
7 A. Right.
8 Q. You bill by minutes in a sense, right?
9 A. Right.
10 Q. And 15 minutes, I guess, is a quarter of an
11 hour?
12 A. Right.
13 Q. Is that how you bill it?
14 A. Right.
15 Q. You were billing down to that level -- at
16 your level of work, you were billing down to that level?
17 A. Yes, uh-huh.
18 Q. And do you understand that then Susannah
19 Wesley would bill the Department of Health for this?
20 A. Yes.
21 Q. And the Department of Health would pay them
22 for that?
23 A. Yes.
24 Q. Now, when you say be creative, though, what
25 do you mean by that?
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1 A. Well, that's one. I think walking to a file
2 cabinet and taking out a file is not --
3 Q. When you say 25 billable hours minimum --
4 A. Uh-huh.
5 Q. -- does that mean that you would have to work
6 25 hours yourself?
7 A. Well, they -- 25 hours direct service or
8 collateral contact. It could be a phone call or -- in
9 the beginning, people were billing and getting no
10 contact; but still, if you get no contact, you made an
11 effort and you can bill.
12 And some people -- some of the therapists
13 maybe or -- would take five clients down at one time and
14 maybe go play basketball, and they can bill five
15 hours -- they can play for one hour; but, you know,
16 you've got five clients. And it costs more to do that
17 if you did it as a group, like, group therapy in a lower
18 rate. So, what you do is just charge an hour for
19 therapy with five people.
20 Q. I understand there were situations where
21 students or kids were taken to movies also?
22 A. A lot.
23 Q. The same way?
24 A. Right.
25 Q. And that was part of their therapy, to go to
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1 a movie?
2 A. Yeah, they had a way of writing it up.
3 Q. Well, but what kind of movies, ma'am?
4 Without giving necessarily names, what level of movies
5 were they allowed to go to?
6 A. They went to anything that -- whatever was
7 playing.
8 Q. There were no restrictions in terms of the
9 level --
10 A. No, no.
11 Q. Now -- well, let me explore that, ma'am.
12 When you say whether it's a basketball game or a
13 movie -- let's use a movie, for example.
14 A. Uh-huh.
15 Q. Typically from, I guess, when you leave the
16 center to go to the movies and to watch it and to come
17 back might take three hours?
18 A. Uh-huh.
19 Q. "Yes"?
20 A. Right.
21 Q. And you're saying if you take multiple
22 children -- let's use as an example five.
23 A. Uh-huh.
24 Q. You take five children, one supervisor, do
25 all of this, go to the movie, watch it, come back. That
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1 person then would bill how many hours?
2 A. You can bill 15.
3 Q. 15 hours, but it's the same three hours,
4 though?
5 A. Right. But for a different child because if
6 you say something different to each child, then -- I
7 mean, they were being creative.
8 Q. Oh, I see. I see. And the same with the
9 basketball game?
10 A. Right.
11 Q. It depends on which side you were maybe?
12 A. Right.
13 Q. Now, were there situations, though, ma'am,
14 when a bill was created when no one saw the child?
15 A. That was a lot of times.
16 Q. And --
17 A. The parents would call us.
18 Q. Well, explain that to us, please.
19 A. Parents would be calling the case manager and
20 saying that, you know, I have a -- you know, we have a
21 meeting here -- you know, we have a meeting; and I
22 haven't seen, like, an IEP and I haven't seen the
23 therapist or the case managers because sometimes they
24 would bill the call to me, you know, for a month or so.
25 So, I would go back and tell the supervisor;
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1 but it's -- I mean, you would look in the file and it
2 says that they did. And so, they have to be called on
3 this because the parents are calling; and they're not
4 being seen.
5 Q. Well, just to make sure we understand, ma'am,
6 you used the phrase "IEP." That stands for Individual
7 Education Plan?
8 A. Right.
9 Q. And these were the plans that were developed
10 for each child; and when it was developed, a number of
11 people were involved. The parents were involved. The
12 teachers were involved. The therapists were involved.
13 A. Right.
14 Q. So, that's what we're talking about, that
15 plan?
16 A. Right.
17 Q. And the plan called for certain types of --
18 A. Services.
19 Q. -- services, right? So that a parent
20 expecting a certain level of services and not getting it
21 would call and ask why it wasn't being provided?
22 A. Right.
23 Q. And when you went to the file to look --
24 without using names -- you went to that student's file
25 and you noticed that someone had --
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1 A. Documented.
2 Q. -- recorded in that file that services had
3 been provided in that same period of time that the
4 parent said nothing was provided --
5 A. Right.
6 Q. -- is that correct?
7 Now, did you have any reason to question the
8 sincerity and honesty of the parent?
9 A. No, no.
10 Q. The parent just wanted services to be
11 provided, right?
12 A. Right. Or else they -- they would document
13 that, you know, they made several phone calls and the
14 person couldn't be reached. And the parent would be
15 upset and said, "They have three of my phone numbers.
16 They have my pager. They have my cell. They have my
17 work number. They have my home number, and no one has
18 been calling me."
19 Q. Did you complain about these practices,
20 ma'am?
21 A. Yes.
22 Q. What happened?
23 A. Nothing, told to take care of my work.
24 Q. Do you believe that there was a lack of
25 proper controls over the payment of funds to these
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1 service providers?
2 A. Yes.
3 Q. Are you with that project any longer?
4 A. No, they closed down.
5 Q. Are you with the Department of Health in any
6 capacity at the present time?
7 A. No.
8 Q. If I may ask, ma'am, did you leave on your
9 own; or were you terminated?
10 A. Terminated.
11 Q. You have -- do you have a basis or an opinion
12 as to why you were terminated?
13 A. Oh, well, the project closed; but I did
14 question why they kept therapists and they kept case
15 managers but they didn't keep any resource specialists
16 that's supposed to be with the families and the voice
17 for the families. And we were just told to go.
18 Q. And you were one of them?
19 A. Yes, I was one -- they only had one for a
20 short while. It was just me; and then, you know,
21 someone else came on.
22 Q. Well, let me ask you this, ma'am. Do you
23 have any basis to testify that you were not retained
24 because of the complaints you had made to the various
25 individuals above you?
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1 A. I couldn't say on that.
2 SPECIAL COUNSEL KAWASHIMA: Okay. Thank you
3 very much. No further questions, Madam Chair.
4 CO-CHAIR REPRESENTATIVE SAIKI: Members,
5 we'll begin with -- proceed with questioning by members.
6 We will adhere to our ten-minute rule. I would like to
7 begin with Vice-Chair Oshiro.
8 VICE-CHAIR REPRESENTATIVE OSHIRO: Thank you,
9 Chair.
10 EXAMINATION
11 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
12 Q. Ms. Pereira, I just wanted to get some
13 clarifications of some of the things you talked about
14 earlier. In particular, when you were talking about the
15 duties that you had with the MST project, I think you
16 had said that your primary duty was to advocate for the
17 families to ensure that proper services were provided?
18 A. Uh-huh.
19 Q. Is that correct?
20 A. Yes.
21 Q. But you later stated that sometimes it
22 overflowed into case management and therapy?
23 A. Yes.
24 Q. Can you explain a little bit more what you
25 mean by your duties being limited and then having to
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1 overflow? And then I think you also said that there was
2 something about a job description you had provided.
3 A. Yes, I have the job description for the
4 resource specialist and the case manager and the
5 therapist, which I brought to the attention of our -- my
6 supervisors --
7 Q. Okay.
8 A. -- and saying, you know, I am -- my work is
9 spilling over into those categories or has been spilling
10 over.
11 Q. Okay. So, actually there is a document that
12 has the list of duties?
13 A. Yeah.
14 Q. And you actually brought these three
15 documents --
16 A. Right.
17 Q. -- to a supervisor and said that "I am
18 actually performing duties under each of these different
19 positions" --
20 A. Right.
21 Q. -- is that correct?
22 A. Right.
23 Q. Okay. When you say that your primary posi --
24 your primary duty was to advocate for one's services,
25 can you explain? Is that a Chapter 56 administrative
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1 process or what kind of advocacy role were you taking?
2 A. Well, I think it was more like a supportive
3 role for the families. And what I'm looking at here, it
4 says to engage the families with the MST team and to
5 assist them with interventions and strengthening -- help
6 them to get into resources in the community instead of
7 being in residential. Like, putting them in the Y after
8 school or district park types of things or helping the
9 families, you know, hook up with Welfare if that's
10 needed and like that.
11 Q. And when you say that there -- your duties
12 had to overflow --
13 A. Uh-huh.
14 Q. -- into the case management and therapy
15 positions --
16 A. Right.
17 Q. -- is that because, in your opinion, the
18 actual therapists and case managers did not have the
19 proper experience or qualifications in their jobs?
20 A. I don't know about qualifications, but I know
21 experience. You know, they did tell me that the -- this
22 is the words they used. They said the crisis case
23 managers they used -- they hired were glorified
24 gorillas, and that's the words they used.
25 And so, I ended up doing the case management;
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1 and they said the therapists were supposed to do the
2 case management but the therapists did not know the
3 process on these islands, you know, the networking, how
4 to go to family court, how to talk to POs, how to
5 contact, the whole process; and with guidance centers,
6 IEPs, they were not familiar with the whole process of a
7 child being a high-end kid.
8 Q. Okay. So, just getting back to what you
9 stated, though, you said that while they may have lacked
10 the inexperience, you weren't sure about their
11 qualifications. Do you know anything about what kind of
12 qualifications these people needed in order to fulfill
13 their positions? Was there something being advertised
14 in the Internet? Are you aware of anything in terms of
15 a baseline of qualification?
16 A. No, I didn't know. What I asked later --
17 because I questioned some of the people's qualifications
18 and -- because they didn't seem to know anything
19 whatsoever.
20 I was told that a masters degree or a
21 bachelors with at least five years experience. I said,
22 "Well, experience where and in what?" Because it
23 doesn't seem like some of the people have it, and I
24 think the masters should have had a -- when I'm looking
25 at this, the masters should have had at least one year
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1 experience in the system, in mental health; and I think
2 they were -- some of them lacked that.
3 Q. Okay. So, I mean, based on your experience,
4 case managers and therapists traditionally should have
5 some kind of formal education, being a bachelors at the
6 very least --
7 A. At least.
8 Q. -- and hopefully a masters with one year of
9 some kind of maybe clinical experience or work
10 experience?
11 A. Work experience knowing the system here. If
12 they were going to work in Hawaii, they need to be --
13 have been able to provide direct service because the
14 ones that we had, they never provided but maybe -- the
15 new hires did; but the earlier ones never provided
16 direct service before or did individual or family
17 therapy.
18 Q. Okay. And you had also talked about their
19 complete lack of knowledge as to some of the basic, I
20 think --
21 A. Diagnoses?
22 Q. Yeah, something like the DSM-IV.
23 A. Uh-huh.
24 Q. Is that -- and just for clarification, that's
25 the diagnostic statistical manual of mental disorders;
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1 is that correct?
2 A. Yes.
3 Q. And that's the actual reference guide
4 accepted in the general scientific community which
5 establishes the diagnoses for various mental conditions;
6 is that correct?
7 A. Right.
8 Q. Okay. And for people such as therapists who
9 are dealing with mental conditions, you would expect
10 that they would be somewhat familiar with this pretty
11 basic or core resource?
12 A. Right, uh-huh.
13 Q. Okay. And, also, I wanted to get a little
14 bit more clarification. When you talked about SOAPing,
15 is that -- can you explain that a little bit more? I
16 mean, that's, as I understand it, the way in which
17 progress notes or actual visits should be documented; is
18 that correct?
19 A. Right, right, uh-huh.
20 Q. Okay. So, what does the S-O-A-P stand for?
21 A. Subjective, objective, assessment, and plan.
22 Q. Okay. So, whatever kind of reports or files
23 you did review --
24 A. Uh-huh.
25 Q. -- lacked this kind of traditional or
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1 accepted format?
2 A. Right. In the beginning, some of them didn't
3 know how to do it and they weren't sure and everyone was
4 just doing it their own way. And I brought it to the
5 attention that, you know, they need to sign it and then
6 not leave any blanks because then you can fill in; and,
7 you know, it's the standards, the clinical standards.
8 So, after that, I gave up. I didn't want to
9 do it.
10 Q. Because a lot of times they just didn't meet
11 the clinical standards. They were just --
12 A. Right.
13 Q. -- writing narrative reports or --
14 A. Right. But I know Terry Lee did try to hold
15 a class on SOAPing and tried to make them follow through
16 on a standard way of recording that -- to follow through
17 on that.
18 Q. But to your understanding, something such as
19 SOAPing is a pretty basic --
20 A. Very basic.
21 Q. Okay.
22 A. That and master treatment plans because none
23 of them knew how to do treatment plans.
24 Q. I think you also stated that sometimes in the
25 files they lacked these service authorizations?
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1 A. We didn't need a service aut.
2 Q. Oh, okay. So, when you did review the file,
3 if they didn't have this SOAPing format, what did the
4 files actually look like, though?
5 A. Well, in the beginning, we -- I think because
6 they were starting up -- and this is what they said.
7 There really wasn't a file or a set way.
8 And I brought it to, I think, Dr. Lee's
9 attention that shouldn't we have files and have it, you
10 know -- how do you say it -- put in different
11 sections -- sections of the file where this belongs and
12 that goes. You know, like, a psych eval goes here; and,
13 you know, a report goes here. Whatever reports from the
14 school IEP, you should have a section that would meet --
15 you know, on the auditor's report, are we -- are we
16 above getting audited or -- because I wasn't sure how
17 the Continuum worked.
18 And so, they started sectioning the files,
19 you know; and then I said -- I -- my assumption was we
20 were supposed to lock the files, you know, have them in
21 a locked place. And then they got a filing cabinet, I
22 guess, and started putting it in there and locking it
23 up.
24 Q. Okay. So, previously they didn't have any
25 kind of security measures over the files?
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1 A. No, no.
2 Q. Okay. And in terms of files when you
3 reviewed them, is there really a clear way where you
4 were able to tell what the prognosis was or how the
5 progress of the actual treatment was going?
6 A. In the beginning, I looked at some of the
7 files; and I -- I just got frustrated. So, I didn't
8 look at the files after that. I just didn't touch them.
9 I just listened to what -- what we had, consultation or
10 supervision. I would listen to what the therapists were
11 saying.
12 Q. Okay. And was anybody in charge of actually
13 having the oversight over the files or the review of the
14 files to make sure that they were at least adhering to
15 some kind of office policy or standards or criteria?
16 A. I think it was Dr. Lee, Dr. Terry Lee.
17 Q. Okay. So, that was Dr. Lee's job, to ensure
18 that the documentation was there in the files?
19 A. I don't know if it was his job, but he was
20 doing it.
21 Q. He was doing it?
22 A. Uh-huh.
23 Q. Okay. Oh, I just wanted to get a little bit
24 more clarification about when the project closed. You
25 said on August 20th, 2001?
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1 A. Partially closed.
2 Q. Oh, partially closed. And thereafter you had
3 two-and-a-half days?
4 A. Two -- I had two-and-a-half days. Some of
5 the therapists that were let go -- I think there were
6 two that were let go and a crisis case manager that was
7 let go.
8 Q. And then I think you also stated that when
9 you were informed of the closing on August 20th, 2001 --
10 A. Uh-huh.
11 Q. -- you attended a meeting thereafter?
12 A. Right.
13 Q. And in this meeting you were given certain
14 directions --
15 A. Uh-huh.
16 Q. -- in terms of how they were going to handle
17 the closing in the next few days; is that correct?
18 A. Right.
19 Q. Who attended this meeting?
20 A. Dr. Terry Lee, myself, the other family
21 resource specialist and my two super -- my two
22 administrative supervisors from HFAA, which was Sharon
23 Nobriga and Vicky Followell.
24 Q. And then when you also talked about the
25 directions being that no one -- that you were not
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1 permitted to go out alone to talk to the families and
2 also in terms of your cellular phone usage, who was the
3 one that gave you those directives?
4 A. My supervisors.
5 Q. Who?
6 A. Sharon Nobriga and Vicky Followell.
7 Q. So, they were the ones that told you you
8 needed to give your cell phone back after?
9 A. Right, Wednesday, two-and-a-half days later.
10 They said Wednesday afternoon.
11 Q. Okay. Just a little more clarification.
12 When you were talking about your experience at the
13 Susannah Wesley Center --
14 A. Uh-huh.
15 Q. -- you had said that one of the directives
16 you were given was to, quote, "be creative" in terms of
17 the billing requirements; is that correct?
18 A. Right.
19 Q. Who was it, if you can name the person that
20 was giving such directions or instructions to you?
21 A. I think it was different people, but I would
22 have to go with our clinical super -- well, I don't know
23 if he was a clinical supervisor -- our project director,
24 and it was Dominic Inocelda.
25 Q. In terms of the billing process --
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1 A. Right.
2 Q. -- can you please explain to us a little bit
3 more what was the procedure that was in place in terms
4 of your billing?
5 Did it get reviewed by a certain supervisor
6 and thereafter they would meet with you to talk about it
7 or, you know, how would they know that you were being,
8 quote, "creative" enough or if they wanted you to be
9 more creative?
10 A. Well, they would meet with us once a week;
11 and they called that supervision. They would meet with
12 us and tell us if we made our quota for that week. And
13 maybe we only made 15 hours. They would say, "You're
14 ten hours short. Can you make it up the following
15 week?"
16 And I said, "If I keep going to that, it will
17 be more than 40 hours a week, I mean, by the end of the
18 month." They would meet with us and say, "You're short.
19 You need to be a little more creative in your billing."
20 You've got to go call -- you have to call them every day
21 if you have to and bill or -- I don't know -- see them
22 every day, go down to the school, call the school, talk
23 to somebody; but make your hours, you know, whether it's
24 collateral or noncollateral -- you know, fam --
25 nonfamily.
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1 And I said, "Well, if they're stable, that
2 means they're doing well," so -- which was -- shouldn't
3 we get pats on the back?
4 "Well, you don't have to be that invasive
5 where you're going to drive down and jump in their
6 face" -- because you're told from the moment you leave
7 you can bill to the point you get to the house and then
8 come back, so --
9 Q. When you talk about them being stable, does
10 that mean that they have reached a point where they
11 have --
12 A. They don't need that intense kind of case
13 management anymore. You know, let's close it or -- it's
14 really hard to close a case.
15 Q. So, at that point when someone is stable,
16 it's more a matter of just periodic monitoring?
17 A. Periodic. I would say maybe one call a week
18 would have been enough.
19 Q. But instead your experience was being told to
20 call --
21 A. Every day.
22 VICE-CHAIR REPRESENTATIVE OSHIRO: Thank you
23 very much.
24 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
25 Vice-Chair Oshiro. Vice-Chair Kokubun followed by
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1 Representative Ito.
2 VICE-CHAIR SENATOR KOKUBUN: Thank you,
3 Co-Chair Saiki.
4 EXAMINATION
5 BY VICE-CHAIR SENATOR KOKUBUN:
6 Q. Ms. Pereira, I just have a couple of
7 questions, actually.
8 A. Yes.
9 Q. Do you have any knowledge about how -- you
10 know, the clients that were being served -- and now that
11 the program has been suspended -- partially suspended,
12 how those clients are dealing with their needs?
13 A. I -- well, some of them, I know they are
14 still being seen by the therapist, not as intense as
15 before because some of -- you know, some of the team is
16 not there; but the families -- they did call me because
17 my name is in the phone book. They did call me and say
18 they needed representation or help maybe in their IEP or
19 something.
20 And the kids -- to me, the kids seemed to be
21 sliding, you know, at this point when they -- because
22 they don't have that intensiveness around them. They
23 were stable for awhile, but I think they were acting out
24 because they felt betrayed. And this is what they
25 use -- they felt betrayed.
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1 And I think a couple of them we are putting
2 in school-based services, but I did say it's not going
3 to -- school-based services does not cover in home
4 anything if something should happen at home.
5 I don't know how school-based services work,
6 if they actually -- if the therapist actually goes to
7 the home when something is happening or if they know how
8 to get a child into Queen's or, you know, implement a
9 crisis plan. I'm not sure, but I still think they need
10 to have some kind of slow transition where they can have
11 maybe not as intensive care at home but somebody to be
12 there a couple times a week in case of a crisis until we
13 are stabilized. But most of them, I think they are
14 pushing them into school-based services.
15 Q. So, your understanding, at least your
16 knowledge, is that there is a level of safety net for
17 these children but -- and families?
18 A. Right. They told me that they were told
19 that -- you know, to take MST home-based; and
20 they wanted to know if they were going to get the same
21 type of services. And I said it's not the same.
22 Q. Right.
23 A. You know, they don't have the case manager.
24 They don't have a family resource specialist. And they
25 don't know. They just were told that -- they were told
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1 that they -- they should stay MST based; and that was
2 it, so....
3 Q. You mentioned Dr. Cunningham and Mr. Randall
4 as being consultants to the --
5 A. Continuum.
6 Q. -- MST. And you mentioned that they were
7 from South Carolina?
8 A. Right.
9 Q. Yeah. They -- did they have previous
10 experience with MST? Is that why they were brought in
11 as consultants -- well, how and why were they brought in
12 as consultants?
13 A. I think they -- they were a part of the MST.
14 That's all I understand. And there was Scott Hengler
15 who created MST, and they were part of his team.
16 Q. I see.
17 A. Because Melisa Rowland who was a psychi --
18 psychiatrist for our team also, that's Scott Hengler's
19 wife.
20 Q. So, were there any other relationships with
21 any of the program supervisors -- you know, did
22 Dr. Cunningham or Mr. Randall have any kind of working
23 relationships previously with Dr. Lee or --
24 A. They also said John Donkervoet.
25 Q. Okay.
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1 A. They were good friends from --
2 Q. So, they had, what, extensive years of a
3 working relationship?
4 A. Uh-huh, yes.
5 Q. How about -- do you know if there was any
6 working relationship -- are you familiar with the court
7 monitor, Dr. Groves?
8 A. No, I know who he is; but I don't know him.
9 Q. Do you know if there was any kind of working
10 relationship there at all?
11 A. No, I don't.
12 Q. This MST -- you mentioned the person who
13 conceived it, the doctor who conceived it. Is this a
14 therapeutic property that's -- you know what I mean? Is
15 it a copyrighted property?
16 A. I believe so because Dr. Randall told me, I
17 think, to buy that prin -- that principle or whatever
18 you want to call it, he would pay 25,000 for it.
19 Q. I'm sorry?
20 A. 25,000. That's what he told me.
21 Q. And in your mind, were you told that -- when,
22 you know, the partial closure of the program occurred,
23 was there going to be some kind of, you know, final
24 report that you would have access to or the other
25 therapists would have access to regarding the results
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1 and the conclusions?
2 A. No.
3 Q. Maybe the budgetary accounting --
4 A. No.
5 Q. -- for the program?
6 A. No.
7 Q. You were not given any kind of --
8 A. Nothing.
9 Q. Okay. So, basically your services were
10 terminated?
11 A. That's it.
12 Q. That's it?
13 A. I never saw them again. They never talked to
14 us again.
15 Q. And all of your association and relationship
16 with your previous clients, it was just something that
17 your client initiated basically for additional services?
18 A. They initiated it or the schools would still
19 call me because I was doing the case management. So,
20 different schools would still be calling me -- because,
21 you know, I've been in the system for a while. So,
22 they -- we know each other and they knew my home phone.
23 So, they would call me and say, "This is what's
24 happening. Where do I go from here? What do I do?"
25 And -- because they said they weren't told
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1 that this was happening until -- I don't know -- early
2 September. So, they wanted to know what was going to
3 happen to their clients -- to the students.
4 And if there was this big a transition,
5 wouldn't an IEP need to be called because there was a
6 change in services? And I would say, "You know, I don't
7 know. Call MST Continuum. I don't know." I just said,
8 "That's usually the process. When we do have a change
9 in service or a termination of a service, you would
10 usually, you know, call an IEP."
11 VICE-CHAIR SENATOR KOKUBUN: Thank you.
12 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
13 Vice-Chair Kokubun.
14 We've been going for about an hour now. So,
15 we would like to take a short break to give our court
16 reporter a rest for at least five minutes.
17 (Recess from 10:04 a.m. to 10:15 a.m.)
18 CO-CHAIR REPRESENTATIVE SAIKI: Members, we
19 would like to reconvene our investigative hearing. I
20 believe our next questioner is Representative Ito
21 followed by Senator Buen.
22 REPRESENTATIVE ITO: Thank you, Mr. Chairman.
23 EXAMINATION
24 BY REPRESENTATIVE ITO:
25 Q. Good morning, Ms. Pereira.
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1 A. Hi.
2 Q. You know, I just wanted to ask a couple of
3 questions. One is, you know, what is MST and how is it
4 related to the education needs of the students?
5 A. How is it related --
6 Q. You know, by using MST as a therapy --
7 A. Right.
8 Q. -- then how is it going to help the youngster
9 or the student improve his educational -- you know, his
10 educational success?
11 A. Well, I think a lot of the kids that we do
12 have -- if I'm looking at MST and I -- in my mind, I
13 don't know what they are --
14 Q. Right -- in your opinion, right.
15 A. I'm looking at how we restructure their
16 behavior and the parents in the home, and I think a lot
17 of the kids weren't going to school at the time or they
18 didn't want to go to school or their diagnosis of
19 depression or something was impeding their being
20 successful in school. And I think the type of
21 intervention that we were looking at was restructuring
22 their thinking. Maybe it would be anger management or
23 something to help them when they were in school to, I
24 guess, control their behavior.
25 Q. So, you think it's working, you know, for the
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1 students?
2 A. I don't know if -- I'm just giving MST a
3 title. I think anybody that cares, a good therapist,
4 and they implemented any type of plan -- whether it be
5 an anger -- or, you know, if you're working with a
6 borderline or something, if you're dedicated and you've
7 drawn the child's strengths and the family's strengths,
8 then whatever is implemented would be successful. I
9 don't know if you needed a title.
10 Q. What is the acronym -- MST, what does it
11 stand for?
12 A. MST, multisystemic therapy. I don't know. I
13 mean, we went through training for a week; but I really
14 couldn't tell you the principles.
15 Q. You know, what is the cost -- you know, I
16 just wanted to find out if there's any improvement, you
17 know, as far as the students', I guess, educational and
18 everything because you mentioned that, you know, the
19 kids go to the movies or --
20 A. Right.
21 Q. -- you know, go play basketball --
22 A. Uh-huh.
23 Q. -- as part of the therapy. And it helps?
24 A. I don't -- I don't know if it was part of the
25 therapy; but, you know, we -- they would send out
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1 therapeutic aides a lot of times with the kids. And the
2 biggest complaint that the therapeutic aides would tell
3 me is they didn't know what to do with them.
4 And I always felt there should be a behavior
5 plan. What is -- what behavior are you going to be
6 working on? But they a lot of times just go in and just
7 sit with the child in the classroom six hours a day.
8 Q. So, baby-sitting basically?
9 A. Baby-sitting, you know, and then they walk
10 them to the next classroom to make sure they go to that
11 classroom.
12 You know, I would question, what if they move
13 out? I mean, what if we're not there anymore? Then
14 they don't go to school. It just starts all over again.
15 I didn't know what the -- you know, they
16 didn't know what the plan was. I didn't know what the
17 plans was.
18 Q. Because I've been having complaints from
19 parents as far as, you know, the youngsters are not
20 getting services or they don't see any improvements --
21 A. Right.
22 Q. -- in the behavior --
23 A. Yeah.
24 Q. -- or their -- or schoolwork. And, you know,
25 I'm very concerned about that.
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1 A. Yes, because we do have special -- I'd say
2 the real special needs kids who are autistic, say --
3 I'll use autism. And they put some people in there who
4 haven't had training. You cannot learn to work with an
5 autistic kid in one training session or even five, let's
6 say. You -- it's ongoing.
7 And there's different methods. Everybody
8 comes and wants to push their method of child training
9 or whatever is the thing for the week or the day or the
10 year. And I think each child is -- you know, each thing
11 is individual.
12 You know, because I myself have a nephew who
13 is autistic; and different things work with different
14 kids. And I've seen some very dedicated TAs going in
15 and actually teaching the child different -- you know,
16 different things to do; but there's others that just go
17 there and they're just there to restrain them. They
18 just restrain.
19 And I've seen kids sitting in the corner of
20 the classroom sometimes, you know, just being restrained
21 or just cornered until the end of the school day because
22 the TAs do not know what they are supposed to do, how to
23 do it, or how to handle it.
24 So, it is -- sometimes, you know -- I know
25 parents have called me and said they were told to sign a
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1 paper saying that the TA was there for so many hours and
2 they weren't; but they sign it because they don't want
3 to lose services. And it was hard enough for them to
4 get that TA in the first place, you know, to baby-sit
5 their kid after school.
6 Q. And they're getting billed -- the state is
7 getting billed for this?
8 A. They're getting billed, right.
9 Q. You know, you -- you know, I heard that
10 one -- I heard from, you know, some special ed teachers
11 on the windward side that some of these providers was
12 getting as much as $500 an hour --
13 A. Wow.
14 Q. -- or maybe more. I mean, do you think
15 that's about right?
16 A. I don't know about the $500 an hour.
17 Q. Per child, per youngster now.
18 A. Oh, yeah, if they're in a program that's
19 after school?
20 Q. Yes.
21 A. Yes, I've heard that.
22 And I always said, "Why can't they go to
23 district park and play tennis" -- or, you know, they
24 have so much things going in the community that -- you
25 know, where we wouldn't need a TA. You know, if you
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1 looked at their strengths and what their interests are,
2 we could put them into programs in the community and
3 save a lot of money off of TAs.
4 But then they say, "We need somebody to
5 transport them and pick them up after school and then
6 take them home." And that's when I say I think
7 sometimes the parents need to take part in the plan and
8 take some of the responsibilities because we cannot take
9 the place of the parent, you know.
10 Q. You know, we look at accountability.
11 A. Right.
12 Q. Ultimately who do you think is accountable?
13 A. I think it goes all the way up. The
14 supervisor of these people, the people who hire the
15 people, and then it goes -- there's no oversight.
16 Q. Uh-huh.
17 A. Because even when our files were checked, you
18 know, when I was with Susannah Wesley, they only checked
19 three months back. If they're -- you know, they would
20 tell us, "Make sure your documentation is up to date.
21 Just go back three months because they don't check
22 beyond that."
23 And they already know which files they're
24 going to be pulling anyway. They'd tell us, you know, a
25 week or a few days ahead of time, "Your file is going to
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1 be checked" and so on. So, it always looks like
2 everything's in place.
3 Q. You know, after you folks worked with the
4 youngsters --
5 A. Right.
6 Q. -- in an IEP, do you folks meet with the
7 teachers?
8 A. Do we meet with the teachers?
9 Q. Yeah, you know, meet with the teachers and
10 talk and make sure that the student's educational plan
11 are being followed?
12 A. The good people do. A lot of them don't.
13 The teachers -- some of the teachers I know never even
14 met the therapist or the case manager. They had no clue
15 who they were except for they saw them once in the IEP.
16 After that, they never saw them again. They never got
17 plans -- and I brought that to the attention when I was
18 in the Continuum that the schools were complaining that
19 they never got a report on how the kid was doing. You
20 know, there was no follow-up.
21 The juvenile justice system -- a couple of
22 POs would call me and say they have no report to present
23 to the judge. They have no behavior plan, no follow-up,
24 nothing. Where do they go from here? The only time
25 they're going to see the therapist or hear from them is
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1 if the child ends up in DH. How are they doing? What's
2 the plan and how are they doing at this point?
3 So, no, there's a lot of no follow-ups. I
4 mean, in a document they're following up; but nobody's
5 following up to see if they follow up. They -- a lot of
6 it is by mouth, word of mouth. If you're saying you
7 did, then I'm assuming you did it. They're -- they
8 treat them like professionals like they should, but they
9 don't follow up to see if they actually did it.
10 REPRESENTATIVE ITO: Okay. Well, thank you
11 very much. Thank you.
12 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
13 Representative Ito. Senator Buen followed by
14 Representative Kawakami.
15 SENATOR BUEN: Can I go at the end?
16 CO-CHAIR REPRESENTATIVE SAIKI: Sure.
17 SENATOR BUEN: Thank you.
18 CO-CHAIR REPRESENTATIVE SAIKI:
19 Representative Kawakami followed by Senator Matsuura.
20 REPRESENTATIVE KAWAKAMI: Thank you very
21 much, Co-Chair Saiki.
22 EXAMINATION
23 BY REPRESENTATIVE KAWAKAMI:
24 Q. I would like to start with -- when they
25 terminated you, Margaret --
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1 A. Uh-huh.
2 Q. -- what were the reasons for termination?
3 A. The project was closed -- closing.
4 Q. The project was closed?
5 A. Closing.
6 Q. So, they didn't need you any longer?
7 A. They just said the project was closing. They
8 didn't say they didn't need me.
9 Q. Nothing else?
10 A. No.
11 Q. And you accepted that?
12 A. Yes.
13 Q. Okay.
14 A. I questioned some things. I said -- I did
15 say, if the Continuum is closing and that's MST and from
16 the -- what you're saying, that all the kids are
17 there -- you know, we couldn't get enough kids into the
18 study when I know better. We still have a lot of kids
19 still on the Mainland, and a lot of kids still going
20 into residential. Some of them were in our Continuum,
21 but we couldn't find enough to be in the study, but
22 you're saying they're doing so well with services that
23 we have now. Then why is an MST home based closing if
24 the Continuum -- if we have such intensive kind of work
25 going, why are we closing?
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1 Q. And you mentioned that you thought this was a
2 waste of money.
3 A. I would say --
4 Q. Can you clarify?
5 A. I don't know how much money they gave out.
6 All I know is some of the people that were working on
7 there were getting moneys that they weren't qualified --
8 and let me say skilled or experienced to get. And I
9 know for a fact that some of them were not working but
10 still getting paid.
11 Q. Did you bring that to the attention --
12 A. Yes.
13 Q. -- of the -- this group? And nothing was
14 done?
15 A. No.
16 Q. Okay. So, they still got paid, et cetera,
17 et cetera?
18 A. Yes.
19 Q. How did that affect the morale of all the
20 rest of the people?
21 A. Angry. A lot of people wanted to defect. We
22 had a lot of meetings, and they said they were going to
23 fix them or some of us who were really working and
24 putting in a lot of hours were promised raises but they
25 never came or we would say, "Well, we're going to
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1 leave."
2 "No, just hold on. You're going to get a
3 raise." And then we're told the person who said that
4 cannot give you a raise.
5 Q. So, they dangled --
6 A. Money.
7 Q. -- different things --
8 A. Right.
9 Q. -- in front of you?
10 A. To keep you on, the hard workers, the ones
11 that, you know, are -- as a research specialist, for
12 one, we were not getting paid overtime. We don't get
13 paid 24 -- we were asked to be 24/7, but we did not get
14 standby or on call like the therapists or the case
15 managers --
16 Q. I see.
17 A. -- because we were contracted, you know,
18 through each of the....
19 Q. I want to go back to the -- you talked about
20 the Mainlanders --
21 A. Right.
22 Q. -- being hired on the Internet?
23 A. They found the jobs on the Internet; and then
24 they contacted, I guess, through e-mail or something.
25 Then they were contacted. Phone numbers were exchanged,
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1 and then they got their interviews over the phone.
2 Q. And you said they did an interview by --
3 A. Phone.
4 Q. -- the phone?
5 A. Right.
6 Q. Okay. So, pretty much all of these people
7 were hired?
8 A. Yes. They flew over and came to the
9 training; and then after the training, they flew back,
10 got their things, and came back.
11 Q. Okay. And what were the stipulations for the
12 hiring of these people? Do you know? Did they have to
13 remain for three years, two years, one year?
14 A. They were told that the Continuum -- we were
15 all told that the Continuum is a continuum.
16 Q. Uh-huh.
17 A. That it would be -- from the last child we
18 brought in, which would be, like, two years from the
19 date we started, would be two years after from four
20 years and that eventually the whole state was going to
21 follow the MST model and it would continue on and on and
22 on.
23 Q. So, it pretty much was open-ended then --
24 A. Right.
25 Q. -- depending on the progress?
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1 A. Right.
2 Q. All right.
3 A. They said -- well, they said, "Don't go
4 anywhere, everybody. This is going to be the thing for
5 Hawaii and" --
6 Q. So, by --
7 A. -- other -- people had other job offers, but
8 they were told not to leave because the Continuum was
9 being to be --
10 Q. I see.
11 A. -- continuing.
12 Q. Okay. At the point you said -- you mentioned
13 several things. They didn't know the culture?
14 A. Uh-huh.
15 Q. They had difficulty --
16 A. Right.
17 Q. -- didn't really know the program --
18 A. Right.
19 Q. -- et cetera, et cetera. Did they provide
20 any kind of in-service for these people?
21 A. No. Towards the end they asked me to provide
22 it.
23 Q. So, you had to do it?
24 A. I didn't do it.
25 Q. Okay.
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1 A. We were closing.
2 Q. You refused to do it? You said you had to --
3 A. Someone -- I said, "Why" -- it's not in my
4 job description; but I said, "Why should I do it?" I
5 mean, you either respect the person's culture in coming
6 here and try to understand it and learn it before" --
7 "you know, especially in this kind of sensitive work and
8 job or go do something else.
9 Q. Okay. Let's see. So, you don't recall -- by
10 them getting all their expenses paid -- they paid for
11 the airfare. They paid for moving costs, et cetera?
12 A. I don't know that. I'm not sure of that.
13 Q. You're not sure?
14 A. No.
15 Q. Okay.
16 A. I don't know that.
17 Q. I just wondered about that.
18 A. But they did say -- I did question, "Why are
19 you hiring so many outside people? You know, what about
20 the people here on our island?"
21 And I was told that because Hawaii has such a
22 small brain pool of people.
23 Q. Did you know of anyone locally who were
24 qualified or had these --
25 A. Yes, yes.
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1 Q. There was quite a few of them, huh?
2 A. Very -- a lot.
3 Q. Okay. And these people were not even
4 interviewed, et cetera? They applied?
5 A. I know one that interviewed -- a couple that
6 interviewed, but they were turned down. They didn't
7 tell them why. And I -- and one that I did refer -- and
8 he left after, like, three months, three or four months
9 because he has a lot of integrity. He said he felt
10 uncomfortable in the position.
11 Q. Do you know if those who came in from the
12 Mainland were paid much -- a different rate than those
13 here?
14 A. I think one did; and I questioned that
15 because she did have, you know, maybe two masters or
16 three. I'm not sure; but I said, "She has no background
17 in mental health." She was paid the highest -- I think
18 at the higher rate. I said, "She has no background,
19 none whatsoever." She didn't know like anything about,
20 like I said, the DSM-IV.
21 Q. But based on her credentials they gave --
22 A. Right.
23 Q. -- her more pay?
24 A. They gave her more pay, but she had no clue.
25 Q. Was it substantial?
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1 A. It was the highest you can get paid in MST.
2 Q. Okay. Let's see. Of course, that billing
3 system blows my mind. You'd think they would have some
4 kind of oversight and capital delineation of what you're
5 doing with all of these bills. You just don't bill for
6 every second and every minute that you're doing
7 something, and it sure sounds like it just went awry.
8 The last question I wanted to ask had to do
9 with Representative Ito's follow-up. Where did the MST
10 model come from?
11 A. Scott Hengler who wrote -- I guess that's the
12 book we got. He wrote it, Scott Hengler.
13 Q. Okay. And he was from what university?
14 A. I'm not sure, but I -- I thought it all was
15 coming out of South Carolina because when his wife would
16 consult with us, she was in South Carolina.
17 Q. Okay. And the -- and the -- you did say that
18 eventually if this worked well, this was going to be
19 the --
20 A. The model for the state.
21 Q. Yeah, the model for all of --
22 A. Hawaii.
23 Q. -- this program; am I correct?
24 A. Right. I was told that if it worked here in
25 Hawaii, that it could work anywhere in the world because
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1 we're such a diverse culture. So, they really wanted it
2 to work here.
3 Actually, I think one -- this is what the
4 consultants told me and our supervisors. They had
5 offered this MST to another city in the United States.
6 I don't know if it was Boston or Philadelphia and they
7 had a year to set up but it didn't go through.
8 So, they brought it here to Hawaii; and
9 Hawaii had -- they gave Hawaii two months to set it up.
10 I said, that is not -- you did not even investigate the
11 domains here, you know, the family, the culture, and
12 everything. Nothing was in place.
13 So, I felt -- from the beginning I told the
14 supervisor, "I feel like we're being set up to fail.
15 Nothing is in place for us to use."
16 Q. So, you would say the program was a flop --
17 A. Yes.
18 Q. -- absolutely --
19 A. Yes.
20 Q. -- or a waste of money?
21 A. I think the theory -- theoretically when we
22 did go out as a team with dedicated people and applied
23 some of the principles of MST with the families, I saw
24 it working. I saw the children getting stable. I saw
25 the families being a little more empowered, the parents
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1 getting back the power.
2 I mean, I'm talking about high-end conduct
3 disorder children, that part of it.
4 Q. Uh-huh.
5 A. But I don't see how we can prevent putting
6 them in some kind of residential because these kids do
7 act up and the parents aren't able to provide and
8 they're not ready maybe to accept a child that is
9 explosive at home.
10 Q. So, Margaret, out of this entire group of
11 youngsters --
12 A. Right.
13 Q. -- that were in this model --
14 A. Uh-huh.
15 Q. -- would you say most of them did not move
16 very far, stayed probably the same level, or maybe
17 dropped back?
18 A. Some of them, I think they were worse -- a
19 couple of them, I said, were worse off than when we got
20 them; and I would say maybe 25 percent were actually --
21 they moved. They actually made some -- a lot of
22 progress.
23 Q. So, a small percentage, 25 percent, you would
24 say?
25 A. Very small percentage. And that's because --
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1 I say that 25 percent had the therapist who was there
2 applying her skills and actually in the home all the
3 time and making sure everything was in place, following
4 a plan and being there 24/7 for the family.
5 Q. Right through then.
6 REPRESENTATIVE KAWAKAMI: Okay. I appreciate
7 all your answers. Thank you very much.
8 Thank you, Chair.
9 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
10 Representative Kawakami. Senator Matsuura followed by
11 Representative Leong.
12 SENATOR MATSUURA: Thank you, Chairman Saiki.
13 EXAMINATION
14 BY SENATOR MATSUURA:
15 Q. Ms. Pereira, actually from your -- listening
16 to your testimony, I'm getting a little more confused
17 about MST, especially some of the points that you're
18 bringing up. In fact, I'm a little bit disappointed
19 because I've been meeting with Tina Donkervoet as well
20 as Anita on MST for a long time and I've been
21 reviewing -- do you -- are you familiar that MST does
22 have a Web site out there listing all of its principles
23 and basically that's where everybody went?
24 A. Yes, I do.
25 Q. What is it -- since we're dealing here with
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1 costs and everything, what is the average cost for
2 Hawaii per child in terms of your services and the
3 average length of service?
4 A. For my services, just my --
5 Q. Oh, no, for average for a child in MST for
6 Hawaii during your program.
7 A. I have no idea.
8 Q. More than four months?
9 A. Oh, I'm not -- say that again.
10 Q. How many -- what -- to what level duration of
11 services is MST here in -- when it was implemented here
12 in Hawaii? Because I know you said that families were
13 promised two years of service.
14 A. Right, for the Continuum.
15 Q. For the Continuum. Do you know average what
16 cost per child? I mean, average per-child costs would
17 have been under your program?
18 A. No.
19 Q. Anywhere over $4,000?
20 A. For the child in MST Continuum?
21 Q. Yeah.
22 A. Well, it depends because we could have a --
23 kids going to Kahi. I mean, we did use the services
24 outside the Continuum. We had Kahi. We still had, you
25 know, Queen's. We had group homes. We had
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1 biopsychosocial programs. That was all included. I
2 mean, it wasn't part of the model; but we ended up using
3 all those services.
4 Q. Yeah, because the -- if you went to the
5 actual Web page on the -- basically on the evaluation of
6 MST and how it's run --
7 A. Uh-huh.
8 Q. -- basically I think one of the reasons why
9 we went into MST is because you're going to hear the
10 usual duration of MST treatment is approximately four
11 months per individual.
12 A. Uh-huh.
13 Q. Would that be a correct statement for Hawaii?
14 A. That's --
15 Q. For Hawaii are we doing our own models again?
16 A. We're doing -- you're talking about MST home
17 based. We're not talking about the Continuum. MST home
18 based is four months, and we're talking about the
19 Continuum research project which was two years per each
20 child.
21 Q. But average -- what I'm trying to get at is
22 for Hawaii.
23 A. Right.
24 Q. Because we've seen from your testimony the
25 way Hawaii went about the model isn't what MST is
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1 supposed to be like.
2 A. Right.
3 Q. So, we went to MST basically because it was
4 supposed to have been more cost effective for us to be
5 going and treating --
6 A. Right.
7 Q. In fact, a lot of the -- I see a lot of
8 similarities between MST and Ho'oponopono.
9 A. Right.
10 Q. That's really similar.
11 A. Right.
12 Q. But we always went -- but when I hear about
13 all your costs and -- cost overruns and how we're
14 billing and all this stuff --
15 A. Uh-huh.
16 Q. -- actually it's -- the way our model -- the
17 Hawaii MST model seems to be way off from the national
18 model.
19 A. They -- that's why they said they closed the
20 project because we ended up using the -- well, the
21 things weren't in place for the -- we ended up using the
22 foster homes. We ended up using --
23 Q. Basically residentials.
24 A. -- every -- all residentials, you know, and a
25 lot of hospitalization.
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1 Q. You know, one question that I've yet to
2 figure out -- somebody actually telling me the correct
3 answer. Maybe you can.
4 You know of a situation you go into a very
5 dysfunctional home where you have -- because basically
6 MST is designed for juvenile delinquents according to
7 non -- in fact, it says it's approaches for serious
8 antisocial behavior, basically juvenile delinquency,
9 which is not really mental health -- not really related
10 to mental health.
11 A. Uh-huh.
12 Q. But, say, you get a family that's very
13 dysfunctional.
14 A. Right.
15 Q. You get a child who is very dysfunctional
16 because of the dysfunctional family. Maybe there's
17 substance abuses involved.
18 A. Uh-huh.
19 Q. So, you go in -- the multisystemic treatment
20 apparently is you empower the whole family -- you work
21 with the whole family, right?
22 A. Right.
23 Q. You cure the family. Therefore, you cure the
24 child?
25 A. Right.
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1 Q. Say, you go into a family; and say the mother
2 or the father has a substance abuse problem and possibly
3 a mental illness. What do you do with the parents? I
4 mean, what treatment does the parents get?
5 A. I'm thinking we did have a case like that,
6 and what we ended up doing is CPS gets involved because
7 you try and work with the parent if they're having -- if
8 they have a substance abuse problem, we ask them --
9 actually they couldn't even relate to the parent.
10 Q. So, basically -- because I know one of the
11 basic principals on MST is if the parent is not involved
12 or does not want to -- is not empowered, it does not
13 work?
14 A. It doesn't work. So, no, they -- the end
15 result is the child is removed from the family because
16 if there's substance abuse there, you're supposed to
17 report that because it's endangerment to the child. You
18 know, it's a type of neglect.
19 If the child isn't going to school and the
20 parents are on drugs, they don't care if they go to
21 school. So, it becomes educational neglect; and that
22 has to be reported to the school and then CPS gets
23 involved because when there's substance abuse, there's
24 also, you know, domestic violence.
25 Q. So, how does MST work in that situation?
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1 A. Everybody was removed.
2 Q. So, how can we have -- be going toward a
3 model where MST is a whole model and the single box for
4 all or our children but a good portion of our children
5 cannot even fit in the box?
6 A. That's right. You're right. I questioned
7 that when I saw this case and I was familiar with from
8 years before. And I said, "We're wasting our time." To
9 me, the answer was to remove the kids because the
10 parents are not going to be compliant.
11 Q. Are you familiar with another one of the
12 principles based on the MST that the -- for optimal
13 effectiveness of the treatment, that the provider of the
14 treatment has to be the same race as the family?
15 A. I didn't know that was a principle. I didn't
16 read the book.
17 Q. Well, that was one of the basic -- basically
18 it says in the Web site that it helps it --
19 A. It does help.
20 Q. So, that's why I was questioning. Why are we
21 bringing so many people from the Mainland when --
22 A. That was --
23 Q. -- basically our multiple -- our bulk of our
24 population's ethnicity is minorities?
25 A. Right. I questioned that, and that's when
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1 they used me to open the door. And I said I'm not going
2 to open the door unless this person is going to follow
3 through. And the family has to trust that this person
4 is going to help them, and I explained that, you know,
5 right now in the islands there's a big Hawaiian
6 resurgence kind of thing going on and they don't trust
7 outsiders and Mainland, you know, people. They say
8 these people are coming in trying to tell us how to
9 raise our kids, and why should I listen to them?
10 And if the therapist is telling them, you
11 know, for the -- what to do, they check with me. "Is it
12 okay for me to do what they're saying? Can I trust
13 them?" You know, so, it was duplication of services;
14 and there was no trust factor. If the therapist wanted
15 the family to do something, they would ask me to do --
16 to ask the family to do it.
17 Q. Also, following up on a -- you said that a
18 lot of the -- times that multiple billing five -- three
19 or four kids, they take them to movies a lot of times?
20 A. Right.
21 Q. Because the basic theory of MST is to empower
22 the family. Basically you heal the family.
23 A. Right.
24 Q. How does taking the child out of the family
25 to movies with three or four of its peers who have
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1 similar problems help strengthen the family?
2 A. Oh, we didn't mix up anybody in MST. We're
3 talking -- when we took the kids out to -- when the
4 therapists took the kids out for basketball, that was
5 when I was with Susannah Wesley under a separate
6 program.
7 Q. So, what about the movie program? I mean,
8 when we --
9 A. Oh, with MST, they did take the client out to
10 the movie or to the beach or --
11 Q. With their family as a whole or --
12 A. No, just the child. They called it respite.
13 Q. So, basically you're giving the parents a
14 break from them?
15 A. A break.
16 Q. Let me get back to what I was following back
17 there. I still can't under -- what happens if one of
18 the family members had suffered from -- your diagnosis
19 as maybe -- oh, from the social worker that that adult
20 had adult mental problem?
21 A. Then if they say they have schizophrenia --
22 the parent had schizophrenia, then it was just helping
23 the parent maintain their medication, make sure they --
24 Q. And who did that?
25 A. Dr. Lee and the therapist.
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1 Q. So, the basic problem that I always had with
2 that one theory or that one -- what you just said right
3 here is we're using our children's adolescent health
4 money for adult mental health and adult programs?
5 A. Yes, right.
6 SENATOR MATSUURA: Okay. Thank you.
7 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
8 Senator Matsuura. Representative Leong followed by
9 Senator Sakamoto.
10 REPRESENTATIVE LEONG: Thank you, Co-Chair
11 Saiki.
12 EXAMINATION
13 BY REPRESENTATIVE LEONG:
14 Q. I just had a question -- first of all, how
15 many children were involved directly in this program
16 that you were working with?
17 A. I can't --
18 Q. How many clients?
19 A. I would say the highest we went to, I think,
20 was about 29, 28.
21 Q. 29?
22 A. 28, 29.
23 Q. And were these clients divided amongst all
24 the therapists?
25 A. Yes. They -- and some of them dropped --
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1 some clients did drop out. You know, parents signed
2 themselves out.
3 Q. You never -- so, at that time, no more were
4 added to it?
5 A. No.
6 Q. I mean, they just kept that same number
7 because eventually --
8 A. They still -- they stopped recruiting in
9 February, I believe, in this year or March; and I
10 asked -- that's when I knew something's wrong.
11 Q. I see.
12 A. So --
13 Q. So, regarding the status of the program today
14 since it's so-called gone --
15 A. Right.
16 Q. -- it still exists in some form; is that
17 correct?
18 A. Yes, I think they were giving a closing date
19 of November 5th.
20 Q. I see, uh-huh. And what do you do now?
21 A. Nothing.
22 Q. Nothing?
23 A. I'm here.
24 Q. All right. So, my question is: As you
25 viewed -- as is talked about -- as you viewed that
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1 something was not apropos, not appropriate in the
2 billing as things were going on --
3 A. Uh-huh.
4 Q. -- and you felt uneasy and other people felt
5 uneasy that this was occurring --
6 A. Right.
7 Q. -- in other words, you said it was not
8 truthful.
9 A. Uh-huh.
10 Q. And you tried to state your concern about it,
11 and nothing was done about it. Could there have been
12 someone else or some other course that you could have
13 turned to?
14 A. I mean, they said to go as far as your
15 clinical supervisor -- first your immediate supervisor
16 and then you go to your clinical supervisor. Then you
17 go to your project director. And then I went as far as
18 the executive director, and then it just stays.
19 Q. And the executive director was?
20 A. For Susannah Wesley it was Ron Higashi.
21 Q. I see.
22 A. Uh-huh.
23 Q. And did you at any time do any anecdotal
24 writing about what you saw, any memoirs of what you
25 heard or had seen?
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1 A. No, no.
2 Q. I guess I have a concern also about the
3 spending and what could have been done for it instead of
4 your just being -- you know, maybe your just being
5 released from the job or what else could have been done
6 about it. Do you have any -- as you reflect on it now,
7 do you have any ideas what you could have done?
8 A. To save the project or to prevent all that
9 was going on?
10 Q. Yes, yes.
11 A. To prevent it? No. I think I went as far
12 as -- I think I took a chance going to South Carolina
13 since I think everybody is intertwined.
14 Q. I see.
15 A. I mean, you know, between -- and we had late
16 night meetings, you know, with different people, you
17 know, including the medical director.
18 And each consultant that came down, I would
19 corner them and say, "We need a meeting. This is what's
20 going on." And I said -- this is exactly what I told
21 them. I said, "You know, there's some people on the
22 team who are not being held accountable."
23 Q. Uh-huh.
24 A. And I'm hearing from parents and they're not
25 even from this island, you know. They're from another
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1 state or, you know, they're not of our culture.
2 And I said, "We have some" -- "these are our
3 people. We have to live here, and our kids and our
4 grandkids are going to grow up with the rest of the
5 population here. We want to make a difference. We're
6 invested here. They can just come, do their thing, pick
7 up and leave if it doesn't work. We have to live here,
8 and we want to make a difference. And we're putting in
9 a lots of hours covering for them, and it has to stop.
10 You know, we've been complaining for going onto a
11 year" -- it was almost a year. "Something has to be
12 done."
13 Q. Thank you. Would you just also requalify
14 what the changing of the envelopes would do? I know
15 that it has to do with money, but it would also sort of
16 invalidate the process of the program.
17 A. I only went on one recruiting thing.
18 Q. Uh-huh.
19 A. The crisis case manager who is usually the
20 recruiter to recruit the families, they would go and try
21 and sell MST.
22 Q. Uh-huh.
23 A. And I know they were told -- because, you
24 know, they told us in the beginning, "Say whatever you
25 have to say to get them to sign to be in the study."
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1 So, they did; and it was a real sales pitch.
2 And then they would have an envelope that they were
3 given before they went out. It either said usual
4 service or MST.
5 Q. Uh-huh.
6 A. And after selling MST, of course, they would
7 want it -- you know, saying we are going to be there
8 24/7. You know, you have a case manager. You have a
9 resource specialist and you have a therapist and they're
10 always going to be there. We're going to help the whole
11 family. It's a family, you know, thing. We're going to
12 take care of, you know, brothers and sisters, you know;
13 and we're going through the whole ecology of bringing
14 uncle in, aunty, you know. We're going to build up this
15 whole support system for you. And, of course, we build
16 them up; and then when you open the envelope, it may say
17 usual service.
18 Q. I see.
19 A. And sometimes they were told to switch the
20 envelopes.
21 Q. I see. Thank you, Ms. Pereira.
22 REPRESENTATIVE LEONG: Thank you, Co-Chair
23 Saiki.
24 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
25 Representative Leong. Senator Sakamoto followed by
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1 Representative Marumoto.
2 SENATOR SAKAMOTO: Thank you.
3 EXAMINATION
4 BY SENATOR SAKAMOTO:
5 Q. Of the 28 or 29, were those particular types
6 of disabilities or disorders or what popu -- what
7 population was that?
8 A. I think the majority had some kind of
9 juvenile justice problem, conduct disorder, maybe a
10 few -- one or two maybe -- I don't know if they were
11 diagnosed right; but they would say bipolar or psycho
12 thymic and --
13 Q. So, from --
14 A. More, let's say, conduct or opposition by
15 insider.
16 Q. So, from your experience, MST would have --
17 that's the appropriate group to try or not?
18 A. It -- that was the appropriate group for --
19 Q. I just heard you saying you go and sell --
20 A. Right. I would say for the conduct disorder
21 groups and oppositional group -- kids, yes. If they
22 have any kind of maybe psychotic kind of problem, I
23 would say -- I don't know who was skilled enough to do
24 that, I mean, not the ones that we had on our team.
25 Q. MST -- well, obviously MST is one of many
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1 different things?
2 A. Right.
3 Q. It's not a cure all for everything?
4 A. No, but you were expected to, you know, do
5 substance abuse and, you know, domestic violence and
6 marriage counseling and, you know, family therapy and,
7 you know, be kind of somewhat schooled in those areas
8 because that's what you're going to be working with when
9 you're working with what they would call a dysfunctional
10 family.
11 Q. Okay. So, then you had who you had, whether
12 they are the chronic, the violent, the substance
13 abuse --
14 A. Yes.
15 Q. -- or juvenile justice?
16 A. Right. There were some we wouldn't take. We
17 wouldn't take autistic kids, any special -- those kind
18 of -- oh, and sexual offenders.
19 Q. So, there's some screening in terms of --
20 A. Right.
21 Q. -- at least what pool?
22 A. Uh-huh.
23 Q. At that point, who determines sort of --
24 well, how well are these children doing in school? How
25 well -- how responsible is their behavior? How safe is
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1 the child? How stable is the child? Who started to
2 determine the scale of good, okay, unacceptable, very
3 poor? Who started to rank where they are at the start?
4 A. I think it would be -- my understanding is
5 that it went to the care coordinator of the family
6 guidance centers. They were -- and then the care
7 coordinator would refer them to MST if they felt the
8 child would fit in MST.
9 Q. I guess I'm asking after -- after they're in
10 MST.
11 A. Oh, after they're in -- it would be the
12 therapist. If they -- once they're in MST, the
13 therapist is the one that would gauge where they are, if
14 they're doing okay in school, if they're doing okay at
15 home, if the parents are complying with the plan or --
16 Q. Earlier you mentioned at least in one case,
17 perhaps, weekly would have been okay as opposed to
18 daily. Who would make the determination or -- as far as
19 the child is progressing and, perhaps, is a candidate --
20 whether it's four months or not, is a candidate for
21 exiting the program? Who would make those
22 determinations?
23 A. I think between the therapist and the
24 clinical supervisor; but in the Continuum, they would
25 stay in for two years. We would keep them no matter
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1 what for two years.
2 Q. Okay. So, for the 28 or 29, there wasn't
3 never an exit provision for these pupils?
4 A. No, after two years then they're out.
5 Q. Even if they're doing well?
6 A. Right. We put them on -- well, we didn't do
7 it; but they said we would maybe start something
8 outpatient where we follow through with them every two
9 weeks instead of weekly.
10 Q. Was there a separate sort of evaluation
11 system for the child for if -- sometimes two or three
12 children and a separate evaluation system for Parent A
13 or Adult A, Adult B, Adult C?
14 A. Generally I think with the therapists, they
15 had intermediary goals that the client and the family
16 would meet, goals on a paper that weekly they would
17 either meet it, not meet it, but not specifically for
18 the whole family.
19 Q. I guess -- I guess when I look at -- you
20 know, some reports on status of a child might be
21 learning progress from one to six?
22 A. Uh-huh.
23 Q. Responsible behavior from one to six, in
24 other words, unacceptable to acceptable?
25 A. Uh-huh.
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1 Q. You know, safety of the child, et cetera. I
2 guess I'm -- the question I'm asking is: In MST or in
3 the way you and your group were operating it, were those
4 evaluations done periodically?
5 A. I think once in a while verbally they would
6 ask, "What's the engagement for one to ten?" That
7 was -- that's the only thing I knew that was gauged was
8 the engagement with the family.
9 Q. And, I guess, at the outset you said the
10 files -- you weren't happy with the process?
11 A. No.
12 Q. But as the system went on, you're not -- I
13 guess you said you sort of disengaged --
14 A. I disengaged myself.
15 Q. So, you don't know -- or do you know at this
16 time if the files do include reports that show this
17 child progressed from a one to a four in learning and
18 from a two to a four in something else?
19 A. I don't know.
20 Q. That's not --
21 A. I wouldn't know because -- I know the
22 therapists document; but I know case managers who go
23 actually respond to the crisis, they didn't do
24 documenting.
25 Q. But --
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1 A. So, I wouldn't know. So, everything would be
2 by word of therapists; and I don't know how they would
3 gauge that.
4 Q. So, do you --
5 A. Except by met, not met, by goals, but not on
6 a scale of one, two, anything.
7 Q. Would the scales have been a way to document
8 progress that could be passed along to other people,
9 teachers, and evaluate whether the child should exit or
10 not? Would that have been a good way to do that or --
11 A. I think if they made it honestly and clear --
12 I mean, I can't vouch for someone.
13 Q. Well, honesty and clarity aren't
14 necessarily --
15 A. Right.
16 Q. -- the word of the day from what you were
17 saying before.
18 SENATOR SAKAMOTO: Okay. Thank you. Thank
19 you, Chair.
20 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
21 Senator Sakamoto. Representative Marumoto --
22 REPRESENTATIVE MARUMOTO: Thank you.
23 CO-CHAIR REPRESENTATIVE SAIKI: -- followed
24 by Senator Buen.
25 REPRESENTATIVE MARUMOTO: Thank you,
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1 Mr. Chairman.
2 EXAMINATION
3 BY REPRESENTATIVE MARUMOTO:
4 Q. You know, it's kind of distressing -- well,
5 first of all, I wanted to commend you for speaking out
6 very early and questioning some of the practices and
7 talking to your supervisors. I give you a lot of
8 credit.
9 Secondly, I don't dispute the fact that you
10 said a large group came in from outside the state; and
11 they were not culturally sensitive. I could see that,
12 you know, this could happen. If they were not
13 qualified -- I believe you they were not qualified; but
14 on the other hand, I think you don't want to kind of
15 profile everybody.
16 A. Right.
17 Q. I think if you went to South Carolina and you
18 became a therapist there, you would probably be a very
19 good therapist also.
20 A. Uh-huh.
21 Q. You didn't want to condemn everybody from
22 South Carolina. But it's distressing to hear about the
23 switching of the envelopes, following up on what
24 Representative Leong was talking about, because the
25 envelopes would determine whether you were in MST or
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1 non-MST and it was to establish a control group for a
2 research project?
3 A. Uh-huh.
4 Q. So, if that was manipulated, then the entire
5 research project --
6 A. Was tainted.
7 Q. -- would be tainted. It would be garbage.
8 It wouldn't be worth anything.
9 And so, I'm just wondering whether, you know,
10 you can say at this time -- do you know who is
11 responsible for manipulating the envelopes and, you
12 know, what's -- do you think it's a -- was it a
13 committee decision or an individual decision?
14 A. I don't know if it was an individual or team,
15 I mean, you know, administrative decision. I don't
16 know.
17 Q. You do not know whether it's an individual
18 division -- decision, but do you think it could have
19 been a team decision? Was it made in a meeting or --
20 A. That, I couldn't tell you. They -- all I
21 know is that that person was told to do it. And I said,
22 "You should bring it to somebody's attention," what
23 we've been doing from the beginning; but we know it's
24 not going to go anywhere. You know, we didn't know
25 where to go.
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1 Q. Would you have any idea how much was devoted
2 to this -- the research project, the research aspect?
3 A. How much --
4 Q. How much money was devoted to the research
5 project?
6 A. I have no idea. I don't know.
7 Q. It's probably an answer probably I should
8 know a bit more than you, but I don't recall at the
9 time.
10 You said the goal was to show that the MST
11 families would be cheaper than the control group --
12 A. Right.
13 Q. -- the usual services?
14 A. Uh-huh.
15 Q. And what -- how did they determine which went
16 into which group?
17 A. You mean, who would qualify for MST or --
18 Q. Yes. How was that determined if it was
19 manipulated?
20 A. A lot of times I didn't know because when I
21 would go to the guidance centers, the care coordinators
22 would say -- or even when I was at court, some of the
23 POs would say, "How do we get our" -- "refer the kids?
24 What is the criteria? Because we have referred a lot of
25 these kids to, you know, the guidance centers and asked
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1 for it to be in the Continuum"; but I said, "But it's
2 supposed to be random."
3 But they said, "Well, you have some of our
4 kids who have met the criteria; and we have a lot of
5 kids with the same criteria but they're not getting it."
6 And then you -- and so, the guidance centers would ask
7 me; and I would say, "I don't know." Even though I
8 know -- knew already something is wrong, I didn't -- I
9 said, "I don't know."
10 Q. Well, they should be random; but whoever was
11 manipulating it might have been wanting to prove the
12 goal to show that MST was cheaper?
13 A. Uh-huh.
14 Q. So, how was that determined? I mean, was the
15 more expensive services -- the children that required
16 more expenses services put into usual -- the services as
17 usual group?
18 A. That's what I would think. I don't know,
19 but --
20 Q. What are the more expensive services?
21 A. I think kids who are hospitalized that need
22 to be in -- people with -- I think kids who have
23 explosive disorders or, you know, hurt themselves, some
24 depression, bipolar, schizophrenia, you know, when they
25 have episodes and they're not maintaining their
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1 medication.
2 Q. More intensive services?
3 A. More intensive.
4 Q. Residential services?
5 A. Yes. But I find that, you know, some kids
6 are just sent to Kahi because, you know, nothing else is
7 available on the island. I mean --
8 Q. Okay.
9 A. Yeah.
10 Q. So, would you say that the services as usual
11 group contained more of this type of patients?
12 A. Services -- yes, yes.
13 Q. So --
14 A. But I think we had our -- we did have some of
15 our fair share, but I think what we had was sort of the
16 norm, kind -- somewhat of the norm because we still used
17 usual services, services which we weren't supposed to.
18 I mean, we still used their biopsychosocial. We still
19 used their group homes. I mean, we still used
20 hospitalizations. I mean, we still did service
21 authorizations and --
22 Q. Okay. So -- thank you. If there was the
23 goal to prove that MST services were cheaper, then
24 probably what was done to the control group was the
25 children that required more expensive services would be
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1 put into that group?
2 A. Yes. I think -- wait. What was the question
3 again?
4 Q. Well, we wanted to prove that MST was
5 cheaper --
6 A. Right.
7 Q. -- per patient.
8 A. Right.
9 Q. Then would not the person who was
10 manipulating the envelopes put the more expensive
11 patients into the services as usual group rather than
12 the MST group?
13 A. I'm thinking that we were supposed to have
14 these homes in place, see; and we wouldn't have to send
15 them to maybe an AEP program or a biopsychosocial
16 program, after-school program, or hospitalization. If
17 we had these MST that identified homes that were skilled
18 and were able to deal with these youths as respite for
19 the, you know, foster families or whatever, instead
20 of -- when they acted out at home, take them and hurry
21 up and put them in Kahi for the night, we could put them
22 in a respite home or provide that service; but that
23 wasn't available.
24 Q. Uh-huh.
25 A. And after school, we didn't have anything --
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1 nothing was followed through. So, the kids ended up in
2 a biopsychosocial program, which is another usual
3 service. I just believe things were not in place the
4 way they should have been.
5 REPRESENTATIVE MARUMOTO: Okay. Well, thank
6 you very much.
7 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
8 Representative Marumoto. Senator Buen.
9 SENATOR BUEN: Thank you, Co-Chair Saiki.
10 EXAMINATION
11 BY SENATOR BUEN:
12 Q. Going back to the Mainland providers or the
13 Mainland specialists that were hired by CAMHD --
14 A. Uh-huh.
15 Q. -- do you know what the salaries were --
16 A. I know some of their --
17 Q. -- that were paid to the Mainland
18 professionals that are hired?
19 A. Oh, you mean -- you're talking about the
20 consultants?
21 Q. The consultants. I'm sorry.
22 A. No, they just -- they just told us; and they
23 were pretty honest that they were very well taken care
24 of.
25 SENATOR BUEN: If the list of all the
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1 personnel and the CAMHD -- if they didn't provide a list
2 of the personnel and their salaries, maybe the Co-Chairs
3 could ask for that from CAMHD.
4 Q. (BY SENATOR BUEN) When you were working at
5 CAMHD, did CAMHD utilize existing Medicaid rates of
6 reimbursement for the same mental health services that
7 Medicaid pays its mental health providers?
8 A. And this is for --
9 Q. Do you know?
10 A. -- MST Continuum or -- we didn't have to
11 service authorize. If we're talking about before, which
12 is that --
13 Q. Do you know if there was a memorandum of
14 agreement between CAMHD and Med Quest?
15 A. No, I don't. I don't know. I don't know.
16 Q. Okay. My questions are in line with that and
17 the rates of reimbursement.
18 A. If we're talking reimbursement, say, like, in
19 '97 to '99, I -- I can remember in '97 when we had a
20 meeting and I can't find the paperwork here but I think
21 for the therapists at that time they were paying -- they
22 were reimbursing the private providers maybe $65 an hour
23 for therapists. And I'm not sure about psychologists or
24 psychiatrists. I'm not sure at that time, but they were
25 paying at a rate -- agencies were paying the therapists
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1 about 19 -- 16 to $19 an hour. Then for the case
2 managers, they were reimbursing $45 a unit; and they
3 were paying from 12 to $13 an hour.
4 Q. Is that what is -- what Med Quest pays out?
5 A. I have no idea.
6 Q. Okay.
7 A. I have no idea.
8 SENATOR BUEN: To the Co-Chairs then, I
9 think -- I would like to see if there was, in fact, a
10 memorandum of agreement between CAMHD and Med Quest and
11 what those -- through the memorandum of agreement, if --
12 what would -- what were the rates of reimbursement to
13 the service -- for the services provided because I would
14 like to know if CAMHD utilizes its provider panel to
15 provide the mental health services and reimburses them
16 at a higher rate.
17 Q. (BY SENATOR BUEN) I understand that many
18 of -- or some of these providers are also Med Quest
19 providers?
20 A. I don't know. I don't know that.
21 Q. Okay. Do you know if CAMHD has an
22 explanation of benefits?
23 A. Benefits for --
24 Q. This -- does the explanation of benefit -- I
25 mean, what I'm looking for is a detail of all the mental
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1 health services provided and paid for by CAMHD and what
2 CAMHD paid for which provider.
3 A. Do they have one?
4 Q. I don't know.
5 A. Oh, you're asking me?
6 Q. Yes.
7 A. They had for our agency. And the list --
8 it's Anna Russell.
9 SENATOR BUEN: I have some other questions,
10 but I think I'll ask them later on to someone else.
11 Thank you.
12 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
13 Senator Buen. Co-Chair Hanabusa.
14 CO-CHAIR SENATOR HANABUSA: Thank you.
15 EXAMINATION
16 BY CO-CHAIR SENATOR HANABUSA:
17 Q. You mentioned an entity that we just heard
18 about in the lot -- last hearing. You said you also
19 worked on the PREL grant to the key project in Kahalui.
20 A. Uh-huh.
21 Q. Can you tell me what exactly was this PREL
22 grant to the key project and what you were doing on it?
23 A. I don't -- I don't know that -- what I was
24 project coordinator of. I don't remember because it was
25 so short, but I -- it was actually trying to get the
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1 children -- the families engaged in participating more
2 in the educational part in school, like, getting them to
3 volunteer. So, there was lot of disseminating
4 materials, holding workshops that would interest them to
5 get them to coming into school and get them to feel
6 comfortable on the campus where they would start
7 volunteering in the classroom and working with the kids.
8 Q. Was this related to Felix kids?
9 A. No.
10 Q. Oh, this is unrelated to Felix?
11 A. Unrelated, but they ended up being Felix
12 kids.
13 Q. They ended --
14 A. Because the workshops the parents were
15 interested in was mostly diagnostic kind of workshops
16 and trying to understand the children's diagnosis.
17 Q. And how long were you at the key --
18 A. Six months.
19 Q. You made a comment that you stopped basically
20 referring others because you knew where the research was
21 going?
22 A. Uh-huh.
23 Q. Do you recall saying something like that?
24 A. Uh-huh.
25 Q. What did you mean when you said you knew
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1 where the research was going?
2 A. I think because -- when they stopped
3 recruiting, we didn't have anything in place that the
4 model said that was going to be in place; and I saw
5 the -- what a lot of the therapists were doing and some
6 other employees weren't doing and putting in place that
7 this was -- and this is a big cover-up. We're going to
8 fail. We're not getting any clients. If we're not
9 recruiting, then how are we going to get clients?
10 So, you know, we just stopped at, like, 20
11 something; and then there was nothing to recruit
12 anymore. I said, then, you know, how are we going to
13 meet our goals? And I just saw that there was such a
14 poor -- you know, poor supervision going on. And I just
15 saw that it -- and I told everyone on the team, "I think
16 everybody should start looking for a job because it
17 looks like it's going to close."
18 Q. Now, how long were you working on the MST
19 Continuum?
20 A. From the beginning, July 10th, a year and one
21 month -- about a year and one month, July 10th, yeah.
22 Q. July 10th, 2000?
23 A. 2000.
24 Q. So, as far as you know, July 10th, 2000 is
25 when the MST Continuum started?
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1 A. Started, as far as I know.
2 Q. Okay. Can you give me a quick lesson in the
3 difference between Continuum and home based?
4 A. The Continuum is a contin -- it's a research
5 project that is con -- let's see -- that we stay with
6 the child for two years. From the time they're
7 recruited and agree to be in the study, we will provide
8 services to the child and the family, the whole family,
9 for two years.
10 And they have a therapist -- a crisis case
11 manager, a family resource specialist, and their own --
12 what do you -- psychiatrist. You don't need service
13 authorizations. The psychiatrist services the whole
14 family.
15 And MST home based is more like three to six
16 months -- in my understanding, it's three to six months
17 depending on the child; and they need authorizations for
18 the services that we were providing. They didn't have
19 case management. They didn't have a resource
20 specialist, but the Continuum ended up hiring TAs on the
21 side after a while also, but not through CAMHD. It was
22 just through word of mouth we -- you know, the parent
23 told us the child needed a TA. We didn't have a TA. We
24 hired a neighbor.
25 Q. To be the TA?
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1 A. To be the TA.
2 Q. Do you know how long MST home based was in
3 place?
4 A. No, I have no idea.
5 Q. Did you ever work MST home based?
6 A. No.
7 Q. Now, you were on staff for the Department of
8 Health?
9 A. I don't know what you mean by "on staff." We
10 were contracted to HFAA.
11 Q. So, what -- well, are you a state -- or were
12 you a state employee?
13 A. No, no.
14 Q. So, who was your employer?
15 A. For MST Continuum?
16 Q. Right.
17 A. HFAA.
18 Q. What does HFAA stand for?
19 A. Hawaii Families as Allies.
20 Q. But who actually hired you?
21 A. Hawaii Families as Allies.
22 Q. Was there any one person in charge of hiring
23 people to work on the MST Continuum?
24 A. There was -- for the Continuum, it was John
25 Donkervoet that I knew of; but I didn't meet him until
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1 we did the training.
2 Q. So, as far as you know, was John Donkervoet
3 an employee of HFAA as well?
4 A. No, he was with the Continuum, the MST
5 Continuum, which was a state -- it was a state -- it was
6 an exempt -- I don't know if it was an exempt position.
7 I'm not sure.
8 Q. What about those consultants that you
9 mentioned from South Carolina? Do you know who paid
10 them? Was HFAA the contracting agency, if you know?
11 A. In my understanding -- and I'm not really
12 sure. This is by word of mouth. It was paid by the
13 state.
14 Q. I was also curious about your statement -- I
15 forgot who it was made to. It was made to
16 Representative Ito's question. You said something about
17 you went for training for a week; but you really
18 can't -- or couldn't tell him what MST theory was all
19 about, something to that effect. Do you remember saying
20 that?
21 A. Yes.
22 Q. What was this training that you were given
23 for a week?
24 A. I believe it was on the MST principles and
25 how we were going to go about working with the families.
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1 Q. Was there anything unique about that training
2 that stands out in your mind now?
3 A. No.
4 Q. No. You keep referring to the fact that you
5 believe that -- whether it's MST or it's just dedicated
6 therapists, you would come out the same way if you had
7 the dedicated therapists on a 24/7 type of work
8 schedule?
9 A. Dedicated skilled therapists.
10 Q. So, is that what you mean by you don't see
11 the distinction between MST, if it's going to be
12 successful, than what dedicated skilled therapists would
13 be doing?
14 A. I didn't see it in the beginning. What I
15 bought into was that they had a team working with the
16 family, that they had the case manager and the family
17 advocate, the voice for the family also, sort of like an
18 overseer. And I thought a team working with the family
19 is a lot better.
20 They can either -- if the therapist isn't
21 available, the case manager is available or the research
22 specialist is available; but when you used -- when the
23 family is in turmoil and you're going in there and if
24 you go alone as a therapist, sometime it doesn't work;
25 but we've seen that when you go in with either a crisis
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1 case manager or a research specialist, you can take
2 one -- you can take the mom and you take the kid and,
3 you know, kind of separate and work together as a team.
4 And if the kid sees only one person coming in sometimes,
5 rather than two or three, he goes, "Oh, well, my mom has
6 an Army here," you know, backing her up then. And
7 there's three people saying it besides mom that this is
8 what has to be done.
9 Q. Did you have a workload of so many cases that
10 you were responsible for?
11 A. Well, the therapists, I think they had three.
12 A lot of them had three, three apiece; and mine covered
13 the whole Continuum.
14 Q. So, you had 28 or 29?
15 A. Right, 28.
16 Q. 28. And were there anyone else in your
17 category?
18 A. There was, and they left -- one left. One
19 was asked -- well, I think a couple was asked to leave
20 because they weren't doing the --
21 Q. Were you the most consistent person then from
22 the beginning, July in 2000, to the time it closed down?
23 A. That I stayed --
24 Q. Yes.
25 A. There's a couple of case managers -- well,
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1 one case manager that stayed from the beginning,
2 excellent case manager.
3 Q. So, the 28 number -- that's a total number in
4 the MST Continuum?
5 A. Continuum.
6 Q. So, the case managers -- you shared the 28
7 cases?
8 A. Right.
9 Q. But any one of you would know No. 1 to 28?
10 A. Right.
11 Q. Now, you also mentioned that -- something
12 about pay scale --
13 A. Uh-huh.
14 Q. -- what was being billed and what was
15 actually being paid. Is this for the MST?
16 A. No, we didn't bill.
17 Q. No, no. I'm -- I mean, what the state was
18 paid. You said $65 an hour for therapists.
19 A. This is for private providers when they were
20 contracting. This is, I'm saying, '97 -- I'd say '97.
21 It's in '99.
22 Q. And this is with Susannah Wesley?
23 A. Right.
24 Q. So, you were saying that the state was being
25 billed $65 an hour for therapists --
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1 A. Right.
2 Q. -- and the therapists working there were
3 getting paid only 16 to 19?
4 A. 16 to 19.
5 Q. And the case manager was being billed out at
6 $45 an hour, but you were actually being paid 12 to $13?
7 A. $13. Right.
8 Q. Were you a case manager at Susannah Wesley?
9 A. I was a case manager, and then I don't know
10 what the rate was for the TA. My understanding was 35
11 or more, but they were paid like $9 an hour.
12 Q. Now, how about at the MST Continuum? How
13 much was a therapist paid?
14 A. It ranged. They had a base salary, and they
15 got 25 percent of their salary for being --
16 Q. The 24/7?
17 A. Yes.
18 Q. And what was the base salary, if you know?
19 A. From what I understand, the base was -- I'm
20 not sure. 34,000 was the base. The high was -- the
21 high, I was told, was 50.
22 Q. 50?
23 A. 50.
24 Q. And as a thera -- I mean, as a case manager,
25 how much were you guys paid?
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1 A. Case managers -- I wasn't a case manager.
2 But case managers, the low was 28 base salary; but if
3 you add the -- it would go up to 36 sometimes if you
4 added the 25 percent.
5 Q. The case managers were also given the 25
6 percent?
7 A. 25 percent.
8 Q. What was your category?
9 A. Family resource.
10 Q. Oh. And what were you folks paid?
11 A. We started out at $10 an hour.
12 Q. And you folks were not given the 24 --
13 A. No, no.
14 Q. -- 7?
15 A. They went up -- after threatening to leave,
16 they went up to a generous $13 an hour.
17 Q. So, when you terminated, you were at $13 an
18 hour?
19 A. Right.
20 Q. You know, that's interesting.
21 Now, you also mentioned and continued to
22 mention the fact that you were concerned about the fact
23 that people were coming in from the Mainland who were
24 not culturally sensitive. That was a major point
25 throughout your testimony.
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1 A. Right.
2 Q. How many of your colleagues -- well, let's
3 start with this first. How many of you worked together
4 at any given time on the Continuum on the 28?
5 A. Oh, geez, I would say -- the whole team
6 including our supervisors?
7 Q. Yes.
8 A. Maybe 13. Let me see. And that includes our
9 administrators or just the --
10 Q. No, the ones that are servicing.
11 A. Okay. Including our supervisors, because
12 they went out with us -- okay. Maybe 12 at the most.
13 Q. 12. And you worked in teams of about three
14 to four each?
15 A. They -- each therapist would get three, about
16 three.
17 Q. So, of the 12 or so of you, how many were
18 from there and how many were not?
19 A. Okay. Let's see. Well, a couple of
20 therapists did leave that were from the Mainland. So,
21 I -- did you want them counted also or just the ones
22 that we ended up with?
23 Q. No, no, all the time.
24 A. All -- I would say about six.
25 Q. Were from here?
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1 A. Uh-huh. No, were not from here.
2 Q. Were not from here?
3 A. Right.
4 Q. And what -- did they tend to be the
5 therapists or --
6 A. Therapists, one case manager.
7 Q. And one case manager. So, they were actually
8 the higher paid jobs?
9 A. Right.
10 Q. And you kept the staff of about 12. Was that
11 about a constant number?
12 A. About, yeah.
13 Q. Senator Matsuura has been talking about MST
14 for a very long time, and something he said and you
15 responded to is very troubling. If I understand it
16 correctly, what Senator Matsuura was saying is that the
17 concept of MST is that you're treating the whole family.
18 That's correct, right?
19 A. Right.
20 Q. But you said that a lot of times the child
21 ends up in residential or institutional care --
22 A. Right.
23 Q. -- of the 28 that you're servicing?
24 A. Uh-huh.
25 Q. So, can you tell me, of the 28, how many --
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1 when you say they end up in residential or institutional
2 care, is that sporadic, like, when they act up or is
3 that, you know, after treating them for four months or
4 so or a given period of time you think they got to go to
5 institutional or residential care?
6 A. You're talking all 28, 29. Some were
7 sporadic. That would be hospitalization. Residential,
8 I would say some were long-term residential. Some were
9 jumping from foster home to foster home to foster home
10 to foster home.
11 Q. So, how many are actually in the home for
12 most of the time of the 28?
13 A. I would have to look at the whole list.
14 Q. Okay. An estimate. The reason why -- if MST
15 is to treat the family and they're spending a good deal
16 of time in either the hospital or in residential
17 treatments or in foster home to foster home to foster
18 home --
19 A. Right.
20 Q. -- it doesn't seem like MST for the purposes
21 that it's established --
22 A. Right.
23 Q. -- is really addressing the problem.
24 A. Right.
25 Q. So, would you say most of these --
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1 A. I would say about half --
2 Q. Half?
3 A. -- were not in the home after a while.
4 Q. Well, wouldn't that just taint the whole
5 sample --
6 A. Yes.
7 Q. -- even -- we have the taint to begin with.
8 And now you really have half of them who are not even
9 fitting the criteria.
10 A. And that was my concern when we started doing
11 service authorizations because no one was qualified to
12 do it because they had never done it. So, they asked me
13 to do some; and I said, no, I didn't want to do it
14 because I -- I didn't think it was part of the model;
15 but then, you know, they started doing service auts for
16 biopsychosocials, for ADTPs, for hospitalizations and --
17 correct.
18 Q. The fact that you didn't need to get any kind
19 of authorization for psychiatric and everything else,
20 did you have any kind of a budget that, you know, one
21 child is entitled to "X" amount of dollars?
22 A. No.
23 Q. So, hospitalization or residential care or
24 foster care -- whatever it is that they may be placed
25 in, was that something that you could just do with M --
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1 A. If they needed -- what we were told, if they
2 needed to be hospitalized and any type of long-term
3 residential, that we need to do a service auth and that
4 Tina Donkervoet needed to sign it and approve it.
5 Q. Have you had any trouble when they needed
6 it --
7 A. No.
8 Q. -- to submit?
9 A. No.
10 Q. So, give me an idea of respite. How many
11 hours -- is there, like, a formula on respite? I mean,
12 you're there 24/7 to service this child and the family;
13 and in addition to that, you provide the family --
14 A. Respite.
15 Q. -- respite. Now, is there a magical formula
16 or an average as to how many hours of respite the family
17 gets from the child?
18 A. No. I think whatever -- if the family would
19 call and say "I need time away from the child" -- I
20 mean, it can be every day. It can be three hours a day.
21 It can be two hours a day. It can be "I need somebody
22 to come and wake him up in the morning and take him to
23 school." So, get up in the morning, pick up my kid,
24 take him to school. When he's done, bring him back
25 home. Or, you know, "I have to go shopping today. Can
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1 you keep him busy for another couple of hours?" Respite
2 can be anything. You know, "He needs to be watched this
3 weekend because I'm working. So, can you take him to
4 the beach? Can you" --
5 Q. It's like baby-sitting.
6 A. It is baby-sitting.
7 Q. Respite is baby-sitting?
8 A. Respite is baby-sitting. Because we have
9 them in foster homes and they -- you know, and I
10 question that -- why are we giving respite to foster
11 parents when they're supposed to be trained --
12 Q. That's right.
13 A. -- and we're paying them to watch them?
14 Q. That's my next question.
15 A. But then we're giving them respite every
16 week.
17 Q. So, you're giving foster parents respite as
18 well?
19 A. Respite -- oh, yeah, all the time; and I
20 questioned that. Well --
21 Q. Respite to foster --
22 A. Foster parents. Okay. Why? Why a
23 respite --
24 Q. Foster parents are also being paid by the
25 state, right?
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1 A. Right, a lot of respite.
2 Q. And they get respite, too. Now, tell me, who
3 provides respite? I mean, can it be a therapist? Can
4 it be a case manager?
5 A. Either the therapist, the case manager --
6 like I said, I refused. So, I never did it. I refused,
7 but I --
8 Q. So, the people who make more money than you
9 are the ones providing baby-sitting services?
10 A. Yeah. I did it a couple of times because
11 everybody was doing their thing, and I did. And it's
12 totally boring, but I just said -- I refused to do it
13 after that. I don't see why we are covering for a
14 foster parent when we -- the state is paying them and
15 the guidance -- I mean, not guidance -- if the private
16 provider agency is paying them that amount of money to
17 be with this child, why are we paying respite? Or if
18 the child is acting up, why are we taking him from the
19 foster home, which is supposed to be able to take care
20 of this child, and taking him and putting him in --
21 overnight in another residential home for about a week
22 and then, when they're done, take him back and put him
23 back in the foster home?
24 Q. I know this is going to sound like a stupid
25 question, but whenever you have a child in a residential
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1 facility or hospitalization --
2 A. Right.
3 Q. -- do we get back any of the money from the
4 foster parents? Do you know?
5 A. Do we get it back?
6 Q. Does the state get credit? Do you know?
7 A. I have no idea. Good question.
8 Q. So, there wasn't a form that you would send
9 in that says, you know, week this to this, child was not
10 there, so foster --
11 A. When we filled out the authorization, we did
12 say when they were there; but I don't know how the
13 private provider agency did it at all, so....
14 Q. I know you also said that you were the only
15 one who was not entitled to any kind of premium for
16 being 24/7.
17 A. Uh-huh.
18 Q. And I also believe you said you're not
19 entitled to overtime, correct?
20 A. Right.
21 Q. But can you tell me, on the average, how many
22 hours you believe you worked in a day or a week?
23 A. In the beginning -- well, some was sporadic.
24 It depends on the kids; but a lot of times, it was
25 called out after hours, a lot of after hours because we
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1 had high-end kids.
2 And it was -- ranged from Kaneohe to Pearl
3 City or from there to the other side of the island.
4 So -- and sometimes at midnight, and it's just there. I
5 couldn't -- I said I felt like I was -- well, my husband
6 said he felt like I was doing it 50 hours a week; and
7 they acknowledged that it was.
8 I said I'm being stretched because you have
9 inexperienced, unskilled people out there. You know,
10 some things can be done over the phone. I don't see why
11 people need to go out all the time because what parents
12 can start to perceive as crisis really isn't a crisis.
13 It can be toned down over the phone. It doesn't have to
14 be direct outreach.
15 Q. Did any parent tell you what they did before
16 this -- this great services that you guys provide or
17 what they did for the child?
18 A. We asked -- that's one of the first questions
19 I asked them when I went out with the therapist and I
20 did my own intake. What has worked and what hasn't
21 worked? And they would say what they've tried, which is
22 very little. I mean, they don't know when they lost the
23 control; but they would say that they weren't getting
24 services. They weren't being seen. The child didn't
25 even know who the child's therapist was but they were
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1 supposed to have had one but they didn't know who it
2 was. They didn't even know who the PO was, but they
3 knew they were in the system. They didn't get any
4 services, but they said they were supposed to have been
5 getting services or the person would not show up.
6 Q. What did they do, though, with the child?
7 Like, they can call you for respite or call the
8 therapist for respite. What did they do before?
9 A. They just let them not go to school, let them
10 be on the street, let them sell drugs, let them do
11 whatever they wanted to do. They said they lost
12 control.
13 Q. They just didn't parent. They just --
14 A. Right, right. And then actually we went in
15 and told them what they can do and what they should be
16 doing; and we sort of just stood behind them while they
17 did it, like, if they had to start putting down rules.
18 I mean, if you put down rules, the kids somewhat test
19 you and up the ante. We're right there when they're
20 doing it and they'll take away this, no TV, no this, and
21 nothing, nothing.
22 Q. My last question is: Was there any kind of
23 final analysis done before you left about the success --
24 quote, "success," however you may define it, of the 28
25 that you actually treated? Was there any kind of
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1 debriefing done with either HFAA or Mr. Donkervoet about
2 what exactly -- I mean, what it did, what it didn't do,
3 where it went wrong? Did you have anything like that?
4 A. Nothing.
5 Q. Nothing?
6 A. Nothing.
7 Q. The program just came to an end?
8 A. Right.
9 CO-CHAIR SENATOR HANABUSA: Thank you very
10 much.
11 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
12 Co-Chair Hanabusa.
13 EXAMINATION
14 BY CO-CHAIR REPRESENTATIVE SAIKI:
15 Q. Ms. Pereira, I just have a couple of
16 questions, first, with respect to MST. You mentioned
17 that MST is partially closed?
18 A. Right.
19 Q. What do you mean by that?
20 A. They kept on, I think, three or four
21 therapists and two case managers to work with them
22 and -- you know, they weren't sure when they were going
23 to be closed. They just said, you know, they were going
24 to start transitioning; but they were just recently told
25 they were shutting down November 5th, to start getting
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1 other services in place.
2 Q. Do you know why MST was partially closed?
3 A. Because we weren't -- they said we couldn't
4 find the population. There was not enough kids who
5 qualified to be in the Continuum and that services that
6 were being provided in Hawaii now were adequate to meet
7 the needs of the kids of Hawaii.
8 Q. So, as a result of the partial closure, do
9 you know if there were any administrative changes that
10 were made?
11 A. Administrative changes, I -- let's see. When
12 I was there, there was changes in -- midway and I mean
13 before John Donkervoet was our clinical supervisor and
14 then he was head of the whole research project; but
15 around January or February, wasn't it -- maybe -- well,
16 maybe it was in May, I'm not sure, maybe May -- we were
17 told that there was a reorganization and that Dr. Terry
18 Lee was heading the whole project. And if we had any
19 complaints, to take it to Dr. Terry Lee about what was
20 going on in the project.
21 Q. So, Dr. Terry is now in charge -- Dr. Terry
22 Lee is now in charge of MST?
23 A. Yes. And then when we were leaving, I think
24 the -- they're -- Cheryl Lamb who is the -- I think she
25 was a quality assurance peop -- person there. I'm not
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1 sure what her title was. She moved up in a position,
2 but I don't know what -- to what title.
3 Q. Okay. Just a couple of questions on the
4 Susannah Wesley contract.
5 A. Uh-huh.
6 Q. I just kind of wanted to see if we could
7 quantify the billing practices.
8 A. Okay.
9 Q. How many special education students were
10 being serviced at Susannah Wesley during the time that
11 you were there?
12 A. I think because we were a research product,
13 they needed at least always 200 to be kept in the
14 research. So, sometimes we would get lower than 200.
15 Maybe the lowest may be, like, 185; but we tried to
16 top -- you know, keep it at 200 or a little over.
17 Q. And how many employees at Susannah Wesley
18 were billing for services?
19 A. Oh, gosh, I would -- I would give it an
20 estimate about -- between 15 and 20. There were some
21 case managers -- there was, like, about 10 or 11 of us
22 case managers and maybe 10 or 9 therapists. And we had
23 TAs. So, I'm not counting the TAs; but they were
24 also -- some were full-time; some were part-time.
25 Q. So, let's say at the high end, 20 employees
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1 were billing --
2 A. Right.
3 Q. -- 25 hours each per week?
4 A. Right.
5 Q. So, that's -- is that 500 hours a week?
6 A. Excuse me?
7 Q. I'm sorry. My math is bad.
8 A. I don't know.
9 Q. 25 hours at 20 workers, 500 hours a week.
10 A. 500.
11 Q. Is it possible -- you had mentioned that
12 there was padding going on with billing.
13 A. Quite.
14 Q. Can you quantify this by giving us a
15 percentage of the approximate number of hours that were
16 padded?
17 A. I couldn't say. I don't -- because we did
18 have a lot -- I mean, not everybody made their 25 hours,
19 by the way. We had very honest people that couldn't do
20 it no matter how creative we were.
21 Q. Just as a guesstimate.
22 A. I would say 250. Let's try half, at least.
23 Q. I'm sorry?
24 A. I don't know. Maybe 200.
25 Q. 200 of the 500 hours were padded?
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1 A. I would think so.
2 Q. Okay.
3 A. Because I wouldn't -- some of the things that
4 they said were billable were -- to me, was questionable.
5 Nobody could answer the questions a lot of times. Is
6 this billable? Is that billable? And they would say,
7 "just bill it." You know, so, we would bill it.
8 Q. What was the billable rate per hour?
9 A. For?
10 Q. What was the average billable rate per hour?
11 A. For therapists? At that time in '95 I think
12 it was 65 for therapists and maybe 45 for case managers
13 and I'm not sure what the TAs were.
14 CO-CHAIR REPRESENTATIVE SAIKI: Okay. Thank
15 you very much.
16 At this point we would like to take follow-up
17 questions, first, from Mr. Kawashima.
18 SPECIAL COUNSEL KAWASHIMA: I have none,
19 Mr. Chair.
20 CO-CHAIR REPRESENTATIVE SAIKI: Members, are
21 there any follow-up questions? If not, Ms. Pereira,
22 thank you very much for your testimony this morning.
23 THE WITNESS: Can I say something before I
24 leave?
25 CO-CHAIR REPRESENTATIVE SAIKI: Sure.
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1 THE WITNESS: I -- you know, I was being
2 called and I was asked why, you know, I would come to
3 the Committee -- if I had any reservations about coming
4 to the Committee; and the first thing that I thought of
5 was my only reservation is: Am I just going to be
6 blowing air because I've been speaking up for the past
7 five years. I mean, I went through every entity that I
8 know. I mean, I went through channels; and nothing --
9 and I was surprised that no one was aware.
10 It seems like everybody was aware except for
11 the people that needed to know; but I was shocked when I
12 read the paper and they're saying, you know, they're
13 squandering money. And people don't -- just don't --
14 they're shocked by it. And I'm thinking but it's been
15 going on forever, and why isn't somebody doing anything
16 about it because we -- there are honest people out there
17 that have brought this matter to, you know, the other
18 people's notices; but nothing's been done.
19 And I would think we need somebody that we
20 can go to and feel safe to go to. I mean, it's not that
21 I won't feel safe. I would have gone in a second just
22 like I'm coming now. I don't -- I'm not afraid of any
23 kind of retribution because I know I'm just telling the
24 truth, but I think we need some kind of oversight
25 committee with dedicated honest people with some
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1 integrity and that knows the system that these people
2 can go to and not feel afraid of retribution because a
3 lot of the workers are state workers.
4 And my phone has been going off the hook
5 telling me, "You need to say this and you need to say
6 that and this is going on and that is going on"; but
7 they cannot come forward because they -- their job is
8 their bread and butter and their family's. But I know
9 it bothers them to have to do some of the things that
10 they're doing, but they don't know any other recourse.
11 So, maybe if you can create something where
12 people can go to and feel safe to say what they need to
13 say or file their discrepancies in their billings and
14 all the cheating that's been going on; and maybe this --
15 you know, the system really needs to be cleaned up.
16 CO-CHAIR REPRESENTATIVE SAIKI: Thank you. I
17 think in large part that is exactly why the Legislature
18 formed this Commmittee.
19 THE WITNESS: Okay.
20 CO-CHAIR REPRESENTATIVE SAIKI: And I think
21 that what we'll find is that the information that we
22 receive from people who are working in the field or in
23 the trenches will be very valuable for this
24 investigative process. We're very appreciative of your
25 testimony this morning.
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1 THE WITNESS: Thank you.
2 CO-CHAIR SENATOR HANABUSA: I would like to
3 add that what you mention is a concern of the Co-Chair
4 and myself and other members of this Committee, and that
5 is the fear of coming forward.
6 We have enacted in the statutes -- and it's
7 been there for a while but it's not used as much but
8 it's there to protect people and that's called the
9 Whistle Blowers Act. And people who may feel that they
10 have been terminated or suspended or unfairly
11 disciplined can bring action, and the reason why we
12 enacted that law is exactly to try and protect that.
13 And we have -- there's a short statute of
14 limitations on it, which is 90 days from the time action
15 is taken; but if we didn't believe that a statute like
16 that was necessary, we, of course, would not put it
17 forward.
18 The other thing is that we are an
19 investigative committee. We have special powers in the
20 Legis -- under the Legislature; and if we find that
21 anyone, anyone, interferes with our witnesses,
22 intimidates them or otherwise affects them, we intend to
23 do something about it, take it to the full prosecution
24 of the law.
25 We also have another law that we just enacted
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1 in 1999, and it's called the False Claims Act. That
2 is -- actually it's called Qui Tam and it's something
3 that began, believe it or not, in the Civil War days.
4 And that's to make sure that people don't rip off -- rip
5 off government because it can happen, as you know.
6 THE WITNESS: Uh-huh.
7 CO-CHAIR SENATOR HANABUSA: You see all this
8 waste. It's very similar to what the General Revenue
9 Service has in that, you know, it pays. It pays a
10 bounty to people who are able to come forward and show.
11 And it's really the state, the Attorney General, who,
12 when he gets that information, is to evaluate it and
13 make a decision as to whether they will go forward or
14 not.
15 We, the Legislature, enacted those laws
16 because that's the only way of, in essence, trying to
17 offer some protection to people for coming forward and
18 telling us because we sit -- as we sit for so many
19 months out of the year, we do not administer. We are
20 not the executive branch. We are not the department
21 heads. And a lot of people feel that we are, but we
22 really are not.
23 So, it may seem like -- you may look at us
24 and say, "What a bunch of lolos. How come they don't
25 understand this? It's so simple and look at" -- it's
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1 because it isn't brought to us because look at who comes
2 before us. It's basically department heads.
3 THE WITNESS: Right.
4 CO-CHAIR SENATOR HANABUSA: It's not people
5 in the trenches like you.
6 But I think I speak on behalf of the whole
7 Committee when I thank you and we thank anyone who will
8 come forward and, you know, we are very sensitive to the
9 fact that, like you said, many people who are still
10 working in the state system are very concerned. And
11 like I said, if we find that they have been threatened
12 and their testimony is affected, we will bring it to the
13 proper authority's attention; but I thank you very much.
14 I think everyone else here thanks you.
15 THE WITNESS: Thank you.
16 CO-CHAIR REPRESENTATIVE SAIKI: Members, at
17 this time, we would like to make a motion to convene in
18 executive session. Is there any discussion?
19 And the purpose of this is to discuss the
20 witness who was listed first in our agenda, Dr. Judith
21 Schrag; and the potential of issuing further Subpoenas.
22 Is there any discussion? If not, we'll take a roll call
23 vote.
24 CO-CHAIR SENATOR HANABUSA: Co-Chair Saiki?
25 CO-CHAIR REPRESENTATIVE SAIKI: Yes.
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1 CO-CHAIR SENATOR HANABUSA: Vice-Chair
2 Kokubun?
3 VICE-CHAIR SENATOR KOKUBUN: Aye.
4 CO-CHAIR SENATOR HANABUSA: Vice-Chair
5 Oshiro?
6 VICE-CHAIR REPRESENTATIVE OSHIRO: Aye.
7 CO-CHAIR SENATOR HANABUSA: Senator Buen?
8 SENATOR BUEN: Aye.
9 CO-CHAIR SENATOR HANABUSA: Representative
10 Ito?
11 REPRESENTATIVE ITO: Aye.
12 CO-CHAIR SENATOR HANABUSA: Representative
13 Kawakami?
14 REPRESENTATIVE KAWAKAMI: Aye.
15 CO-CHAIR SENATOR HANABUSA: Representative
16 Leong?
17 REPRESENTATIVE LEONG: Aye.
18 CO-CHAIR SENATOR HANABUSA: Representative
19 Marumoto?
20 REPRESENTATIVE MARUMOTO: Aye.
21 CO-CHAIR SENATOR HANABUSA: Senator Matsuura?
22 SENATOR MATSUURA: Aye.
23 CO-CHAIR SENATOR HANABUSA: Senator Sakamoto?
24 SENATOR SAKAMOTO: Aye.
25 CO-CHAIR SENATOR HANABUSA: Senator Slom is
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1 excused. Co-Chair Hanabusa is aye.
2 We will convene in executive session. Shall
3 we give an estimate?
4 CO-CHAIR REPRESENTATIVE SAIKI: Yeah. We'll
5 hold -- we'll convene in Room 329 next door, and we will
6 be back here at -- in one hour, at 12:45, recess.
7 (Lunch recess from 11:43 a.m. to 12:58 p.m.)
8 CO-CHAIR SENATOR HANABUSA: Members, we are
9 calling the Committee back into session. Our next
10 witness is Dr. Ken Gardiner. Dr. Gardiner, will you
11 come forward, please?
12 Co-Chair Saiki, will you administer the oath?
13 CO-CHAIR REPRESENTATIVE SAIKI: Mr. Gardiner,
14 do you solemnly swear or affirm that the testimony you
15 are about to give will be the truth, the whole truth,
16 and nothing but the truth?
17 KENNETH GARDINER: I do.
18 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
19 CO-CHAIR SENATOR HANABUSA: Thank you,
20 Dr. Gardiner.
21 We will be following the same procedure that
22 we had for the prior witness, which is now returning the
23 questioning over to Mr. Kawashima.
24 SPECIAL COUNSEL KAWASHIMA: Thank you, Madam
25 Chair.
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1 THE WITNESS: Before we get started, I'm a
2 cancer patient. It's very cold in here, and I need to
3 put my hat on my head. I'm very cold.
4 CO-CHAIR SENATOR HANABUSA: That's fine.
5 THE WITNESS: And so, it's no indifference to
6 you.
7 SPECIAL COUNSEL KAWASHIMA: Thank you.
8 EXAMINATION
9 BY SPECIAL COUNSEL KAWASHIMA:
10 Q. Please state your name and address, business
11 address.
12 A. Kenneth Charles Gardiner, G-A-R-D-I-N-E-R.
13 The Subpoena was misspelled. Business address is
14 3232 Kilauea Avenue, Diamond Head Family Guidance
15 Center.
16 Q. And I understand, sir, that you are employed
17 by the Department of Health in the child and adolescent
18 mental health division, as you say, the Diamond Head
19 Family Guidance Center; is that correct?
20 A. Yes.
21 Q. And what position do you hold there, sir?
22 A. Mental health supervisor.
23 Q. And what are your duties as a mental health
24 supervisor?
25 A. First and foremost, I provide individual and
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1 clinical supervision to the care coordinators, mental
2 health care coordinators, that are assigned to me. I
3 provide collaborative services for the two complexes
4 that I supervise, which are the Kaimuki school complex
5 and the Kaiser school complex, an array of collaborative
6 services with the DOE, Parent Partners With Families,
7 et cetera.
8 Q. All right. Will you, sir, describe your
9 educational background for us?
10 A. I have a doctorate in education and
11 leadership administration. I hold two masters degrees.
12 One is a masters of divinity degree with an emphasis in
13 counseling, as I was a Roman Catholic priest for 17
14 years; and I have a masters in counseling.
15 Q. And your doctorate, sir, was in what area?
16 A. Education, leadership administration.
17 Q. And from which institution did you receive
18 that?
19 A. The University of St. Thomas.
20 Q. And when was that, sir?
21 A. In 1998.
22 Q. All right. Now, before becoming a mental
23 health supervisor at the Department of Health, you did
24 have many years of experience, I understand, with
25 counseling, mental health, and program development; is
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1 that correct?
2 A. Yes, it is.
3 Q. And where did you get that type of
4 experience?
5 A. It came from a cadre of experiences. As a
6 Roman catholic priest, I started out doing pastoral
7 counseling; but besides that, I worked as a supervisor
8 of psychiatric counseling positions at a mental health
9 psychiatric hospital. I worked in various positions as
10 senior counselor for adjudicated juvenile delinquent,
11 in-house therapists, as well as the director of training
12 for 13 states for behavioral health and juvenile
13 delinquent programs.
14 Q. Thank you. Dr. Gardiner, we've been informed
15 that there are high-level Department of Health
16 administrators who are discouraging members from the
17 Department of Health from discussing matters with the
18 state auditor's office and/or this legislative
19 committee. Do you know that to be true?
20 A. I would like to clarify your answers before I
21 answer it.
22 Q. Sure.
23 A. The discouragement would not come in the
24 place of "do not testify." There was some concern over
25 whether a private citizen would be able to testify in
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1 conjunction with being a Department of Health employee.
2 After that was clarified, there have been no
3 oppositions to anyone testifying; and even with the
4 opposition, it was that -- to make sure that you knew
5 that you could have legal representation, the office of
6 the AG present, when you do testify, if so needed.
7 Q. In other words, initially there was some
8 concern about being discouraged from coming here?
9 A. Yes.
10 Q. And you say that was clarified?
11 A. It was clarified.
12 Q. As a matter of fact, you were referred to the
13 department of the Attorney General and you talked to one
14 of the deputies there regarding this matter, did you
15 not?
16 A. Yes.
17 Q. And they told you to come here and testify
18 fully and truthfully?
19 A. Yes.
20 Q. And that is why you're here today?
21 A. I'm here of my own volition and not because
22 of the AG's office.
23 Q. I understand that; but initially, though, as
24 far as you or others in your position were concerned,
25 did there appear to be some members who were, I should
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1 say, high-level Department of Health administrators who
2 were discouraging you and people like you from coming to
3 the legislative auditor's office or this legislative
4 committee initially?
5 A. Initially, not discouraged. There was
6 confusion over the process of how it was being done; and
7 once that was clarified and we got the head, I don't
8 work independent -- I do work with supervisors. And so,
9 to take my lead, do we participate in this -- did the
10 director of health give permission for us to
11 participate? We needed some guidance from above; and as
12 an on-line supervisor, I'm not going to encourage the
13 workers I have to go and do anything that is not within
14 their rights or in the jurisdiction of their job without
15 clarification from the top down.
16 Q. Thank you. And, Doctor, there are people who
17 work under your supervision, are there not?
18 A. Yes.
19 Q. And what -- what title do they have? What
20 job description do they have?
21 A. They're mental health care coordinators.
22 Q. All right. And how many of these care
23 coordinators do you supervise?
24 A. I supervise nine, and they comprise the
25 Kaimuki and the Kaiser complex -- school complexes.
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1 Q. And these -- each of these nine coordinators,
2 care coordinators, they manage the care of a number of
3 special education children?
4 A. Yes, they do.
5 Q. And what are the typical kinds of services
6 that these care coordinators provide for these students?
7 A. We run the whole cadre of the clinical
8 standards manual. It would take me a while to tell you
9 all because each one is individualized. I have 142
10 cases that are active now; and so, to tell you in
11 general all -- I could say I run through every one of
12 the clinical standards, which is quite a bit. And I
13 don't know if you want that timing to go through from --
14 Q. No.
15 A. -- hospitalization all the way to TAs all the
16 way -- the whole spectrum.
17 Q. Any types of services that a special
18 education child would need would come under that
19 purview?
20 A. Yes, it would.
21 Q. Now, has the Department of Health entered
22 into contracts with private providers for some of these
23 services?
24 A. Yes, we have.
25 Q. And these private providers, they submit
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1 bills to the department for payment?
2 A. Yes, they do.
3 Q. And who at the department authorizes the
4 payments of these bills?
5 A. When we do a service aut or a service
6 authorization, it depends. There are some services,
7 like, procuring of a TA that a care coordinator can
8 submit themselves; but as it moves up the level, the
9 more intense the service is, the more the line item has
10 to be signed off. Depending on what the service is, I
11 may sign off on certain services; but when it comes to
12 flex, respite, and partial hospitalizations, those go
13 directly to the branch chief.
14 Q. Is the branch chief the highest level of
15 review of these types of bills?
16 A. He along -- in conjunction with the clinical
17 director, yes, and CSO, clinical services office, may
18 have some input or oversight; but as of recent, that --
19 the buck stops with the branch chief and the clinical
20 director at the branch.
21 Q. Okay. In your case, who is the branch chief
22 you're referring to?
23 A. Dr. David Drews.
24 Q. And then the clinical director is whom?
25 A. Dr. Martin Hirsch.
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1 Q. Now, is there a system in place, Doctor, at
2 the Department of Health to ensure that the services
3 being billed for were actually provided?
4 A. Yes and no.
5 Q. Explain that for us, please.
6 A. And I can only refer to the services that I
7 deal with mostly on a daily basis, and it's with
8 therapeutic aides commonly called TAs.
9 You can procure a service for a TA and you
10 can initially check and see, when the care coordinator
11 goes out and does a site visit, if that service is being
12 performed; but at many of the schools or the levels,
13 there is no sign-in that says "I was here for 'X' amount
14 of hours." And sometimes we won't know that the service
15 hasn't been performed until a parent will call and
16 complain or a teacher will call and say there was an
17 incident or something took place. When we ask for
18 documentation of the billing, did they show up?
19 Sometimes not even the teachers can remember if they
20 signed up.
21 It's an inconsistent checks and balance
22 system. Then we're forced to go to the agency and check
23 with what they submitted as their billable hours and
24 their time scale as according to what someone else said
25 services were performed, but they're -- there seems to
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1 be a gap.
2 Q. Well, this signing-in system you just
3 described, Dr. Gardiner, would you not expect that to be
4 a basic type of system for accountability?
5 A. I would hope so. It made -- it would make my
6 job a whole lot easier. If I have to go after someone
7 to say "Did you perform this service," a lot of times
8 it's after the fact, after the Department of Health has
9 already paid; and it's hard to track it.
10 Q. Well, you're not the first person to come
11 here and testify about services being performed or
12 claimed to have been performed and to be billed for
13 where a family has complained that the service was not
14 given. That has happened to you also, sir?
15 A. Yes, it has.
16 Q. And has that happened to you on more than one
17 occasion?
18 A. Yes, it has.
19 Q. And has that happened to you on more than one
20 occasion with certain providers?
21 A. Yes, it has.
22 Q. And can you identify for us which providers
23 those would be?
24 A. Loveland Academy; and with TA services, it's
25 multiagencies. So, it's across the board.
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1 Q. But Loveland Academy is one that sticks out
2 in your mind as far as multiple complaints -- receiving
3 multiple complaints about this type of a problem where
4 services were claiming to have been provided. A
5 statement was submitted for that service, perhaps even
6 paid; but you learned later that the service was not, in
7 fact, provided?
8 A. Correct.
9 Q. And that information was provided by a parent
10 to you personally?
11 A. By a parent and also by a care coordinator
12 who may have gone on the grounds to check; and when
13 certain services were not in place when -- where we were
14 questioning about it, sort of like we got the shut door
15 in our face.
16 Q. And as far as those services, sir, not having
17 been provided, would -- based on your experience in this
18 area, sir, would a parent have any reason to complain
19 about a service not being provided when, in fact, it
20 was?
21 A. Generally, no.
22 Q. How about care coordinators? Would they have
23 any reason to indicate that service -- they did not see
24 someone providing a service when, in fact, a service was
25 provided?
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1 A. Most definitely not.
2 Q. Now, are you aware, sir, of cases where there
3 has been payment made by the state for services that may
4 not have been needed by a child?
5 A. Let me clar -- I have to put clarity to that.
6 Q. Go ahead.
7 A. Services that go to a child are a team
8 treatment decision made in an IEP. No one person
9 decides if a child will have a service or not. So, when
10 a service is provided, it is because of the IEP. The
11 team makes that decision.
12 The care coordinator makes sure that those
13 services are provided and procures the services. So, no
14 one person -- I have come upon instances where the
15 services should have been terminated; and they were not.
16 They were ongoing. The child had progress. And because
17 of independent or private providers, sometimes the
18 documentation just supported that we continued to see a
19 need to have this done.
20 Now, we have the luxury and the necessity of
21 having a clinical director who can go in and do some
22 things for us and make sure that that doesn't happen.
23 Q. Who is that clinical director, sir, again?
24 A. Dr. Martin Hirsch.
25 Q. And is he new to the project?
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1 A. Yes, he is.
2 Q. When did he start?
3 A. I would say about three weeks ago.
4 Q. Do you have any idea why Mr. -- Dr. Hirsch?
5 A. Yes.
6 Q. Why Dr. Hirsch was retained three weeks ago?
7 A. No, I don't. And for the information of the
8 panel, I've only been working with the Department of
9 Health for two months. That's important that you know
10 that as well.
11 Q. Before that, with whom were you working, sir?
12 A. I worked for the University of Houston Cancer
13 Research Center.
14 Q. All right. But that two months you've been
15 here has been full-time?
16 A. Yes, it has.
17 Q. Now, have you -- or I should say, are you
18 aware of cases, Dr. Gardiner, where payment has been
19 made by the state for services that exceeded service
20 levels provided by the CAMHD clinical standards?
21 A. Rephrase your question for me, please.
22 Q. All right. For example, have you seen
23 situations where a TA provides services for two students
24 at the same time --
25 A. Yes, I have.
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1 Q. -- and bills each one separately?
2 A. Yes, I have.
3 Q. In other words, double billing in that
4 situation?
5 A. Yes, I have.
6 Q. Tell us about that.
7 A. There is an instance where a TA may enter in
8 documentation. In the billing, you can't tell
9 automatically. He's saying he provided this service;
10 and it's until after the fact you look at it, this TA
11 has two kids. And he may be working for two agencies,
12 but he has billed -- he has brought the two kids
13 together. And he billed for them separately when the
14 IEP may have stipulated that he is only supposed to be
15 with that child at that time; but, yet, there were two
16 kids that he was servicing or she was servicing at the
17 same time.
18 And it's very hard to detect. You really
19 have to scrutinize the documentation. And sometimes the
20 TAs are not as astute as they should be and they write
21 it and they tell on themselves. And I guess when we're
22 giving QA or oversight, we pick this up; and we call
23 them on it.
24 Q. And the reason, I think, sir, that you can't
25 tell sometimes is because they're billing this same
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1 one-hour period --
2 A. Yes.
3 Q. -- in two separate files; is that correct?
4 A. That's right, correct.
5 Q. But, in effect, you're double billing, aren't
6 you?
7 A. Yes, they are.
8 Q. Getting paid twice for the same thing?
9 A. Yes.
10 Q. All right. Now, you also, I think, already
11 testified that there were cases where the state made
12 payment to some organization for services that were not
13 rendered?
14 A. Yes.
15 Q. And you mentioned Loveland Academy as being
16 one of them; is that correct?
17 A. Yes.
18 Q. Now, have you raised these problems with your
19 supervisors?
20 A. Yes, we have.
21 Q. And in your mind, do you believe that
22 additional oversight would be needed to correct these
23 types of problems?
24 A. Yes.
25 Q. And now, do your -- have your supervisors
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1 agreed with you as far as this additional oversight
2 being necessary?
3 A. Yes. And at present, I can say that Loveland
4 Academy is having a fiscal audit done on their contract.
5 Q. And by whom, sir?
6 A. CAMHD contracts division.
7 Q. And you learned about this very recently,
8 didn't you?
9 A. Yes.
10 Q. And you learned that this fiscal audit was
11 initiated very recently, didn't you?
12 A. Yes.
13 Q. And --
14 A. But prior to that -- I need to add to that --
15 prior to that, we were going to have our own
16 investigation management-wise with the branch chief.
17 And we had raised many concerns; and to his own credit,
18 he says before we enter into that, I need to bump it up
19 and see if there's something else going on. So, we were
20 being heard. It was just we were anxious. Like, let's
21 get heard, like, tomorrow.
22 Q. When you say your branch chief, to whom are
23 you referring to?
24 A. Dr. David Drews.
25 Q. And would you agree, sir, if you know,
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1 whether or not they were planning to do this before you
2 started working for them and bringing these problems to
3 their attention?
4 A. With Loveland Academy, it had been done in
5 the past.
6 Q. By whom?
7 A. I understand the branch chief and his
8 management team had already initiated one such talk with
9 them about services that were being provided.
10 Q. The branch chief, Mr. Drews, had a discussion
11 with people at Loveland Academy?
12 A. Yes.
13 Q. By the way, who would these people at
14 Loveland Academy have been?
15 A. The only one I'm privy to have -- that I deal
16 with is Dr. Maggie Koven. That's the person that I
17 choose to deal with at my level. I am not privy to who
18 the investigation dealt with prior to my coming to the
19 Department of Health.
20 Q. Dr. Koven, K-O-V-E-N?
21 A. Yes, Maggie Koven.
22 Q. Well, you suggest that you chose to deal with
23 Dr. Koven and no others -- I mean, others above her?
24 A. Simply because she signs the documentation on
25 progress notes, and that was a major concern of mine.
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1 Q. Who -- do you know if there is anyone above
2 Dr. Koven?
3 A. There is, should be the executive director;
4 and I do not know her name.
5 Q. Dukes? Does that sound familiar to you?
6 A. Yes.
7 Q. Dr. Dukes, perhaps?
8 A. Yes.
9 Q. Patricia Dukes?
10 A. Yes.
11 Q. You have not dealt with her?
12 A. No, I haven't.
13 Q. So, you say recently there -- you learned
14 that Mr. Drews was going to do an audit or have a
15 discussion with the Loveland people about their
16 practices?
17 A. Uh-huh.
18 Q. "Yes"?
19 A. Yes.
20 Q. Are you aware as to whether or not Mr. Drews
21 knew about these problems before you came?
22 A. I think he knew about the problems. I also
23 know that they took preventive action in having a
24 meeting prior; but as I came on -- because the
25 complaints from my care coordinators had surfaced to a
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1 level where I needed to bump it up a level and say I am
2 very uncomfortable with the amount of complaints that we
3 are getting -- or even from parents having called me.
4 And my inability to get phone calls answered
5 back from Loveland Academy frustrated me because they
6 could have been simple matters that maybe I could have
7 troubleshot, but there were no returned phone calls from
8 any of their administration to me.
9 Q. Doctor, have you witnessed care coordinator
10 disputes -- other than yourself -- care coordinator
11 disputes with Loveland about the provision of services?
12 A. Yes, I have.
13 Q. And what usually happens in those cases that
14 you've seen?
15 A. Particularly the case that I am most familiar
16 with at Loveland Academy, there are two of my care
17 coordinators -- they actually witnessed services not
18 being provided. And the discussion with Loveland was
19 that we're not going to cut a service aut because you
20 didn't provide.
21 And having been privy to the conversation on
22 the other end, Loveland was pretty resistant in saying
23 that we have a contract. We do this, this, and this;
24 but they were not willing to provide documentation to
25 show that they had provided the service. There was no
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1 progress notes from them saying that the service was
2 performed. And so, the care coordinator did not put a
3 service authorization through; and they felt they should
4 have been paid for it even though we had no
5 documentation.
6 Q. Well, were they paid?
7 A. Eventually, yes.
8 Q. Who approved that payment?
9 A. The branch chief.
10 Q. Mr. Drews?
11 A. Dr. Drews, yes.
12 Q. Now, do you know if Dr. Drews has any
13 connection with Loveland Academy?
14 A. I am not familiar with any connection.
15 Q. Do you know they -- that they have the same
16 address -- I should say, their addresses are in the same
17 building?
18 A. Whose address?
19 Q. Loveland Academy and CPU.
20 A. Oh, I don't know that they are in the same
21 building. I do know that there is a banner for CPU on
22 the outside of one of Loveland's buildings. I was not
23 aware that they were housed in the same building.
24 Q. Well, what I asked was whether or not
25 Drews' -- Dr. Drews' business address for CPU is the
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1 same building that Loveland Academy has an address in.
2 A. I would assume it is.
3 Q. You're not aware of any other connection
4 between the two, though?
5 A. No, sir, I'm not.
6 Q. Do you know if Loveland Academy -- well, what
7 is Loveland -- excuse me. "CPU," what does that stand
8 for?
9 A. I think it's Central Pacific University.
10 Q. And is that an accredited institution, sir?
11 A. I have no idea. I don't --
12 Q. Do you know what types of degrees Central
13 Pacific University provides?
14 A. No, sir, I'm not privy to it.
15 Q. Do you know whether or not Central Pacific
16 University gives degrees for people who end up at
17 Loveland Academy and working for the Department of
18 Health?
19 A. No, sir, I have no knowledge of that.
20 Q. Would that surprise you?
21 A. It would.
22 Q. Now, are you aware of other DOH personnel who
23 have complained about Loveland other than yourself?
24 A. Other MHS1 supervisors have complained about
25 Loveland. Loveland is a place where -- I think, with
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1 people who have integrity right now because of the
2 questions we have and they're not being answered would
3 not want to send a child to Loveland until some of our
4 answers -- our questions were answered.
5 Q. Do you know why the Department of Health
6 would pay Loveland Academy for these types of services
7 as you have suggested?
8 A. Right now, it's the only show in the town
9 that helps with high-end autism kids.
10 Q. Do you think that's enough justification for
11 Loveland to bill for services that they did not provide?
12 A. It's not enough justification but the other
13 thing is then we start sending autistic kids outside of
14 the state and that's a bigger concern of mine than
15 Loveland is right now, when you divide a family up.
16 Q. Are you suggesting, sir, that it is -- you
17 would rather have someone bill the State of Hawaii
18 through the Department of Health for services that were
19 not performed on a consistent basis --
20 A. No, sir.
21 Q. -- that you would approve of that, sir?
22 A. What I am saying, because Loveland is the
23 only one that provides this high-end service right now,
24 I'm in a rock and a hard place. Where else do I send
25 the kids without being in contempt of Felix? Where else
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1 do I send -- I really don't like Loveland, if you want
2 me to be honest with you; but where else am I going to
3 get my kids serviced? What else do -- what other
4 choices do we have?
5 Q. Do you know whether or not there are other
6 choices?
7 A. Loveland is the choice for certain services.
8 Q. Well, certain services. What services are
9 you talking about?
10 A. Day treatment for a high -- high-end autistic
11 kids.
12 Q. And you're suggesting there's no one else who
13 can provide that treatment?
14 A. Not in a day treatment program, no, sir.
15 Q. There are no other providers in the State of
16 Hawaii that you feel are qualified to provide those
17 types of services?
18 A. Not that I'm aware of that the State of
19 Hawaii has a contract with.
20 Q. Well, when you say "not that I'm aware of,"
21 are you suggesting that there aren't such providers or
22 that you're just not aware of them?
23 A. We're given a providers' manual; and in that
24 providers' manual, Loveland takes care of a certain
25 group of children that we deal with. And for that
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1 certain group of kids that we deal with, Loveland is the
2 show in town.
3 Q. Sir, that manual you're given, who puts out
4 that manual?
5 A. The Department of Health.
6 Q. Do you know if the Department of Health has
7 actually looked for other providers that are qualified?
8 A. I'm not privy to that.
9 Q. Do you know if the Department of Health is
10 certifying that Loveland is the only facility in the
11 entire state that can provide those types of services
12 you're talking about?
13 A. I'm not privy to that.
14 Q. Now, do you get reports from Loveland?
15 A. Yes.
16 Q. You're smiling. Tell us why you're smiling.
17 A. I'm smiling because all of the progress
18 reports that I get are signed by Dr. Maggie Koven, and
19 how she could provide service to all these children is
20 amazing to me.
21 And it causes me concern because the reports
22 are the same over months of periods of time. They're
23 computer generated and I know people have their own bias
24 about it; but if Dr. Maggie Koven is providing that kind
25 of oversight and she's not the actual TA, I am very
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1 concerned how she gets that information on every child
2 for every day and every treatment and how she signs off
3 on them.
4 And if you read the documentation, sentences
5 are placed in -- carefully misplaced. All you have to
6 do is go back a couple of months and it's the exact
7 same. I've even gotten documentation where they took
8 out the wrong kid's name and left a kid's -- another
9 kid's name in the report that was submitted. So, at
10 best, the documentation, I have no confidence or
11 credibility with it.
12 Q. It sounds like a fill-in-the-blanks thing.
13 A. Yes or re -- or fill in the sentence or
14 remove the sentence statement type deal.
15 Q. Well, what you're saying is that Dr. Koven
16 obviously doesn't provide the direct service?
17 A. No, Dr. Koven does not -- definitively does
18 not.
19 Q. And what you're saying, though, is that
20 you -- you're not aware of how the provider that
21 provides this direct service gives the information to
22 Dr. Koven such that you get a computer-generated report
23 with what appears to be month to month the same
24 information in that report?
25 A. It makes it very difficult to track the
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1 progress of the child if the progress notes are saying
2 the same thing month after month after month.
3 Q. Could that child have been in that same
4 condition month after month after month?
5 A. Then why are we paying for the service if the
6 child is not improving?
7 Q. That's an excellent point.
8 A. If that's the case, we need another show in
9 town.
10 Q. That's an excellent point.
11 Has Loveland ever told a care coordinator
12 that they were not welcome on their premises?
13 A. Yes, they have.
14 Q. Tell us about that, sir.
15 A. I have one care coordinator who is pretty
16 outspoken and she went to check up on the kid and she
17 found that the TA was not present with the kid, as was
18 specified by the IEP. She kept going back, kept going
19 back unannounced to make sure that she could get a
20 meeting with this TA; and she was told that she was not
21 welcome on the campus and that she was causing friction
22 by coming to check up to see.
23 And when I called to check up about it
24 because I feel if the Department of Health is paying the
25 money, we have the right to step in to see what we're
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1 getting from our moneys -- for our dollar value; and no
2 one returned the call to me, no one. And I repeated the
3 call about 17 times and I have documented the dates and
4 the times and not one person from Loveland ever returned
5 a call.
6 Q. Were those calls left on voice mails or
7 directly with a person?
8 A. Some were left directly with the
9 administrative assistant, and others were -- I was
10 forwarded to a voice mail or to a voice vacuum.
11 Q. And, sir, how -- over what period were those
12 messages left?
13 A. In two months -- the two months I've been
14 hired are the two months I've been trying to get contact
15 with Loveland.
16 Q. That 17 times, you're saying, happened in two
17 months?
18 A. Yes.
19 Q. And on none of those occasions -- where you
20 left messages in one form or another 17 times, not one
21 of those calls were returned?
22 A. I only know Dr. Maggie Koven exists because I
23 see her signature. I have never spoken with her. I
24 have never heard her. I have never seen her.
25 Q. As far as a care coordinator is concerned,
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1 though, Doctor, isn't it essential that that care
2 coordinator be able to observe the student's progress?
3 A. Yes, it is.
4 Q. And so that if whoever it was at Loveland
5 prevented that care coordinator from observing the
6 treatment or the care that the child was getting, then
7 that care coordinator couldn't do their job; am I
8 correct?
9 A. That's correct.
10 Q. And that's what your concern was?
11 A. Yes.
12 Q. You've testified, then, sir, that you
13 understand that an audit is now being performed by the
14 con -- well, I understand the contracts division of the
15 Department of Health of Loveland?
16 A. No, of CAMHD.
17 Q. I'm sorry. CAMHD. And are they also
18 reviewing the bills that have been submitted by Loveland
19 for services provided -- or not provided, I guess?
20 A. I'm not privy to what the whole scope of the
21 investigation is.
22 Q. The audit of CAMHD, do you know when that was
23 initiated?
24 A. We were informed about it about three weeks
25 ago, but it may have started prior to that.
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1 Q. Do you -- well, strike that.
2 Were you told why this audit was initiated,
3 whether it be three years ago or -- not three years --
4 three weeks ago or before that?
5 A. Probably because of the amount of complaints
6 that had arisen in the field and from parents probably.
7 Q. But, to your understanding, these complaints
8 were there even before you started, though?
9 A. Yes.
10 Q. In fact, these complaints, to your knowledge,
11 were there a long time before you started?
12 A. Yes.
13 Q. Again, if you know, do you know why the
14 Department of Health has started this audit of CAMHD
15 recently, like, two weeks ago or somewhere within that
16 realm?
17 A. No, I don't.
18 Q. Do you know if it has anything to do with the
19 fact that this legislative committee is investigating a
20 number of things, one of which is the problems there?
21 A. Any answer I would give would be speculation
22 in regards to the legislative committee and CAMHD.
23 I do know, as a supervisor, my complaints
24 were heard; and I thought it was gracious that they were
25 heard because I was the new kid on the block, per se.
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1 But in the past, I have been told they had sit down and
2 spoken with Loveland about the contract and the services
3 they had provided; but I'm not privy to knowing that
4 there's a correlation between this honorable committee
5 here and CAMHD's timing.
6 Q. Let me ask you about another area, Doctor, I
7 think you're aware of having to do with differential in
8 pay. Are you aware that a therapeutic assistant gets
9 paid by providers --
10 A. Yes.
11 Q. -- what they get paid? What do they get paid
12 sir?
13 A. The going rate today is between 12 and $15.
14 Q. And what -- what do these providers charge
15 the state in turn for the same services provided by
16 these TAs?
17 A. I think it's between 60 -- $65.
18 Q. About four times -- well, three to four times
19 more?
20 A. Maybe, approximately, yes. I'm not
21 absolutely sure.
22 Q. Are you aware of, sir, of any overt item or
23 hidden overt item that would make it necessary for these
24 providers -- I believe some of which are nonprofits --
25 to charge the state three or four times what it costs
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1 them to hire these TAs or pay for these TAs?
2 A. No, I'm not. I do consider it somewhat
3 unethical in that the TAs are the ones who are providing
4 the direct care service, and they get the smaller amount
5 of money for the job that they perform.
6 Q. By the way, do you know whether or not these
7 TAs get fringe benefits that might justify a larger
8 amount being charged to the state?
9 A. Most of them do not. Depending on the hours
10 that they get, they may not be able to get benefits; and
11 so, sometimes the hours have to be increased so that
12 they can go to their agency and say, "I need benefits or
13 else I can't work."
14 Q. I see. Are any of them contract employees,
15 to your knowledge?
16 A. Contract in what --
17 Q. Independent contractor is what I'm talking
18 about, if you know.
19 A. I don't know.
20 Q. Now, one last area, Doctor, it has to do with
21 your knowledge or information about what we've asked
22 others questions about involving MST.
23 A. Uh-huh.
24 Q. Do you have knowledge about MST?
25 A. Yes.
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1 Q. Multisystemic therapy?
2 A. Yes.
3 Q. What is your knowledge of op -- in that area?
4 A. It's basically used with juvenile delinquents
5 or children who have had some -- some dealings with the
6 court system, oppositional defiant children; and it's
7 supposed to be empowering the family to take back
8 control over their child and their system -- and that's
9 the home system. But most of my dealings are not with
10 MST. It's with MST Continuum.
11 Q. There was a Continuum at one time. That's
12 been terminated, though, right?
13 A. It may have been terminated, but it affects
14 me in a very real way because those cases are being
15 transferred back to the Family Guidance Centers and my
16 care coordinators.
17 Q. We've heard testimony about that, sir.
18 You testified, though, that MST,
19 multisystemic therapy, was originally designed for
20 juvenile delinquents --
21 A. Uh-huh.
22 Q. -- is that correct?
23 A. Kids who have had inter -- problems with the
24 court system who are oppositional defiant conduct
25 disordered, those type problems.
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1 Q. Now, to your knowledge, sir, is MST a proven
2 therapy for all special education children?
3 A. No.
4 Q. Now, you mentioned this project or, perhaps,
5 I, in my questioning of you, mentioned the Continuum,
6 MST Continuum?
7 A. Uh-huh.
8 Q. Now, do you know who the director of that
9 project was?
10 A. I don't know who the director, per se, is. I
11 do know whom I've had interaction. I've heard the name,
12 and it's John Donkervoet. That's the clinical director,
13 I'm assuming.
14 Q. All right. Oh, one last area, sir, the
15 Department of Health uses different building codes --
16 billing codes for various levels of care; is that
17 correct?
18 A. Yes.
19 Q. Are you familiar with the Billing Code 15101
20 for a therapeutic assistant?
21 A. Yes.
22 Q. Can you explain when and how such care is
23 authorized in combination with services for autistic
24 children?
25 A. Rephrase your question. Just a moment.
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1 Q. Can you explain how --
2 A. Because of my chemotherapy I'm having a hard
3 time focusing. So, when you speak quickly --
4 Q. I understand.
5 A. -- I don't process as quickly as you go.
6 Q. Thank you for reminding me. I do speak fast,
7 I'm told.
8 Would you explain for us, Dr. Gardiner, how
9 care is authorized in combination with services for
10 autistic children?
11 A. In the IEP, all services are where the team
12 comes together for the school. We come together in an
13 IEP meeting and all the stakeholders and the
14 stakeplayers come together and we decide what services
15 are best for this child.
16 The DOE has its component, the education
17 component; and the DOH has its component, which is the
18 mental health component. We come together and we agree
19 upon what services are needed and the level and the
20 intensity of services that are needed for this child
21 based upon whatever the diagnosis has been or is, the
22 current diagnosis, psych evals, and whatever information
23 we have and what else is needed for the family as well.
24 Q. Now, that -- through the process of the IEP,
25 though, certain care is authorized?
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1 A. Yes.
2 Q. And are such services that are provided still
3 being provided for and paid for?
4 A. Yes.
5 Q. And those --
6 A. Those services won't stop, sir, until the IEP
7 team comes back and has deemed that this child has
8 progressed past this or those services are no longer
9 needed.
10 Q. I see. Are there situations, though, Doctor,
11 that you're aware of where these care or services are
12 not authorized where services are still being provided
13 and billed for?
14 A. No, sir.
15 SPECIAL COUNSEL KAWASHIMA: That's all I
16 have. Thank you, Doctor.
17 THE WITNESS: Thank you.
18 CO-CHAIR SENATOR HANABUSA: Thank you,
19 Members. Please remember we have the ten-minute rule.
20 We'll begin first with Vice-Chair Kokubun followed by
21 Vice-Chair Oshiro.
22 VICE-CHAIR SENATOR KOKUBUN: Madam Chair, I'm
23 fine. Thank you.
24 CO-CHAIR SENATOR HANABUSA: You're fine?
25 Vice-Chair Oshiro?
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1 VICE-CHAIR REPRESENTATIVE OSHIRO: Thank you,
2 Madam Co-Chair.
3 EXAMINATION
4 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
5 Q. I just have a few clarification questions for
6 you. Earlier you had stated that in terms of the
7 providers for autistic children, the only one that you
8 were aware of in this providers' manual was the Loveland
9 Academy; is that correct?
10 A. For day treatment, yes.
11 Q. Okay. And --
12 A. And they have an after-school component as
13 well.
14 Q. Okay. And when you talk about treatment for
15 high-end autistic kids, what is the -- is there a model
16 or a particular type of recommended scope of treatment
17 that's provided for most students?
18 A. Autism is a very hard developmental
19 disability to pin down. You will hear people say they
20 are experts in autism. Professionally I don't know of
21 any experts in autism. Most kids who are high-end
22 autism can't tell you what the problem is. So, when we
23 go in and try to diagnose and people say they are
24 experts in it, they're not.
25 We can only go from the research and the data
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1 that we do have. And so, there are a wide range of
2 behaviors and diagnostic tools; but as far as being an
3 expert, I really can't answer that. I can't even tell
4 you I myself and my background as being an educator who
5 have dealt with autistic kids know enough about autism
6 to make those kinds of decisions. That's why I would
7 refer them to a clinical director or a psychiatrist or
8 someone who really knew.
9 It is very difficult to just pigeonhole and
10 say this -- this about autistic kids; but we do know
11 when it comes to providing certain services to kids that
12 we do consider high-end autistic kids, there has to be
13 the one-on-one interplay with them and a management
14 control and even giving respite for parents who deal
15 with kids who are very high-end autistic children.
16 Q. Okay. And given that you stated, I mean, at
17 time it's very difficult not only to diagnose but treat,
18 in your experience with Loveland -- I guess this is a
19 two-part question -- what kind of services are they
20 providing to meet those ends? And do they have a wide
21 range of experience and types of services to meet all of
22 the varying and different demands that you talked about
23 in terms of the wide range that needs to be --
24 A. If I go by credentialing of the
25 administration of Loveland, I would say "yes"; but
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1 actually when I get the documentation and my progress
2 notes, I say "no."
3 Why? I have one person signing off on
4 everything, and that's not good enough for me as a
5 clinician. And that's the only thing. I just can't
6 take one person's -- and that person isn't performing
7 the service. I don't know what kind of clinical
8 supervision the people get at Loveland. And so, I can't
9 really make a decision on that program because I'm not
10 privy to all that that program has; but if I look at
11 what -- the credentialing of the people who have the
12 oversight, I would say they should know what they're
13 doing.
14 Q. Okay. But based on what you've seen from the
15 documentation, Loveland is -- as I understand it,
16 they're providing -- or they require a therapeutic aide
17 to be with the special needs child; and on top of that,
18 they provide additional services for -- to meet the
19 autism. So, in essence, the TA is just sort of a basic
20 need; and beyond that, there's additional types of
21 treatment or services that need to be provided to meet
22 autism?
23 A. Yes. And they can -- they're supposed to be
24 an all-inclusive program. So, everything that they
25 need, including the TAs, should be provided right there
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1 at Loveland.
2 Part of the problem is we're adding TAs to a
3 program that's supposed to already have TAs in. They
4 will say, "We need a TA for this and that"; and we're
5 saying, "Isn't this included in the price package that
6 we pay you already?"
7 Q. And is there an average of this price package
8 in terms of how much you're paying for the TA and also
9 how much you're paying for the services, the autism
10 services?
11 A. I really stay away from fiscal matters as a
12 clinician. I don't like to be sidetracked when I'm
13 talking about kids and mental health about a dollar
14 amount. I leave that to the branch chief, CAMHD
15 contracts people.
16 I will state my concerns, but very seldom
17 will you ever hear me talk about money because it is not
18 a focus for me in doing supervision in that way.
19 But I do know this with Loveland: The
20 problem is: If you tell me your contract is all
21 inclusive, yet, you call me and tell me you need a TA;
22 and your program is supposed to provide a TA, I have a
23 problem with that.
24 I want to know what's your justification, and
25 we do -- I do have cases where we're constantly asked to
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1 provide TAs and their program is supposed to already
2 provide TAs for children who are in their day treatment
3 or after-school program.
4 Q. Okay. And sort of just to sum up, as I
5 understand it, I think, as you mentioned, one of the big
6 problems you have in reviewing the progress notes of
7 Loveland is that they seem to be sort of form oriented
8 and signed particularly just by one person?
9 A. Yes.
10 Q. Okay. And in addition to that, you've also
11 cited to an example where a care coordinator was refused
12 access to actually do some monitoring or, I guess,
13 unannounced site visit --
14 A. Yes.
15 Q. -- to make sure that the TA is performing
16 their proper job?
17 A. Yes.
18 Q. Okay. In addition to that, you also tried to
19 issue a number of follow-up calls, particularly about
20 17, just to try and find out what's going on; but to
21 date, you haven't received any response?
22 A. Not a call, not unless they've called since
23 I've been here today.
24 Q. Okay. So, given all of that, what is the --
25 I don't understand how in this way you're supposed to be
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1 able to measure the actual progress that is going on
2 with a child or any child since you've been -- since
3 there are all these blocks for you to do any proper
4 assessment.
5 A. I'm going to go on professional license, and
6 I would hope that the people at Loveland have
7 professional integrity that they would not lie about a
8 child who is autistic. And because of professional
9 courtesy, I would hope that a clinician would be
10 forthcoming and honest with me.
11 Part of the problem I have, because I'm not
12 able to get my questions answered, then it begs me to
13 question where is the ethical dilemma -- if you're
14 partnering with me and if I am the DOH paying the bill,
15 don't you think you ought to return a phone call to me
16 so I can have some measurement system, so I can have
17 something to gauge?
18 It's very -- it's very hard for me to keep
19 telling the care coordinator to keep going back, keep
20 going back when they keep running up against a brick
21 wall. That's very hard for me to do.
22 Q. Okay. I just want to get -- clarify one more
23 statement you had said earlier; and it regarded, I
24 think, your being asked about unnecessary services being
25 provided. And you had said something along the lines
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1 that there are times when services should have been
2 terminated but they keep going on. What would be a
3 proper basis for the termination of services?
4 A. There have been instances where a
5 therapist -- all therapeutic aides or TAs work in
6 conjunction with a therapist. And there have been
7 instances where we have felt that the therapeutic aide
8 was not needed and the therapist found a justification
9 for it. And somehow that has to go with -- in line with
10 the goals, but we could clearly see that the child had
11 progressed. Even the parent felt that the child had
12 progressed. And the therapeutic aide wasn't warranted;
13 but if the therapist is saying that this service needs
14 to be in check, then we run sometimes -- who do you
15 believe, the parent? Do you believe the therapist or
16 the TA? You're caught in that dilemma.
17 So, you would hope you would want to bring
18 this back into the IEP; but there comes a -- what I call
19 political wrangling. You get in an IEP; and you don't
20 want to appear before a family that you don't have your
21 act together, that the therapists, the TA, the
22 Department of Health -- we're all arguing in front of a
23 parent who just wants her child -- or their child to
24 progress.
25 I won't sit and be privy to anybody arguing
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1 in front of a parent with their child present or
2 anything like that. I will terminate a meeting on
3 behalf of the Department of Health. We just won't do
4 it. I won't do it on my own personal integrity.
5 And so, you try to have a meeting prior
6 before and say, "Tell me why all of this is happening.
7 Give me your justification."
8 And if that person is the therapist -- and
9 I'm not saying on their dishonest -- but sometimes I do
10 question why would a therapist say this when it's
11 clearly indicated that this child is meeting all these
12 benchmarks that we have to continue with this high level
13 of services when it can be demoted or downplayed?
14 And you just hope that on that person's
15 integrity you can bring it down and sometimes you run
16 into those dilemmas and you hope that you can solve
17 them.
18 Q. Okay. Just one more area. In terms of being
19 a therapeutic aide, is there any basic qualifications or
20 education that you need to have?
21 A. Basically, two years of college and at least
22 two years of clinical -- or one year of clinical
23 supervision having worked with children or it can be
24 substituted -- you may have a degree -- depending --
25 there are three levels of TA, Level 1, Level 2, and
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1 Level 3. And depending on where that level is, the
2 level of education and the level of training or clinical
3 supervision may have been increased because of the need
4 for the child.
5 Q. Okay. And I understand that you -- earlier
6 you had made some statements that you have a lot of, I
7 guess, faith or would hate to question clinical
8 integrity of some of these other clinicians when it
9 comes to their progress notes or the actual progression
10 of a child through this program; but if there was some
11 reason to question whether these people are even
12 actually qualified in the first place to be therapeutic
13 aides, how does that -- how do you address that?
14 A. If it's a credentialing issue, I first call
15 down to CAMHD division -- we have a credentialing
16 division where we check credentials of people and see if
17 they have met the minimal standards that are required of
18 a person.
19 If it's about a therapist, we have a clinical
20 director and sometimes we go in and we sit and we look
21 on best practices. What do we know empirically that
22 really works? Is this happening with this kid? Has it
23 happened?
24 Then we'll begin to question back and forth
25 and open up a dialogue to see. If I'm not performing
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1 the service with the child directly and have no
2 observation of that child, then I have no recourse but
3 to accept what this person is saying and hoping that
4 their integrity is intact; but when there are enough red
5 flags, the place I will go will be to the clinical
6 director and to the branch chief and say, "Hello,
7 something isn't right here."
8 And hopefully we can resolve that in a milieu
9 approach or a team approach and usually that's how it
10 gets solved but that's a lengthy process because you
11 have to be careful.
12 Once parents get entangled with a
13 therapist -- and I don't -- the word "entangled" is
14 misused. Once parents get accustomed to having a
15 therapist and the child builds up a relationship with a
16 therapist, you want to be very careful about removing
17 all of a sudden someone that this child has forged a
18 relationship with. So, it's not as cut and dry. It is
19 a process that we go through. It's just that the
20 process takes time; and in that time and interest, money
21 may be being -- still being spent.
22 Q. Okay. And you had earlier cited to an
23 example where you had some concerns and some complaints
24 and you had taken them to, I understand -- is that
25 Dr. Drews?
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1 A. Yes.
2 Q. And that is sort of following the example you
3 had stated in terms of there were a lot of red flags and
4 your recourse or monitoring them compelled you to go see
5 Dr. Drews?
6 A. Uh-huh, yes.
7 VICE-CHAIR REPRESENTATIVE OSHIRO: Okay.
8 Thank you.
9 CO-CHAIR SENATOR HANABUSA: Thank you,
10 Representative Oshiro. Senator Buen followed by
11 Representative Ito.
12 SENATOR BUEN: Thank you, Co-Chair Hanabusa.
13 EXAMINATION
14 BY SENATOR BUEN:
15 Q. If Loveland Academy is the only game in town,
16 is this the provider that services the neighbor islands
17 also? Would you know?
18 A. I don't know. I don't know.
19 Q. Would you know of any other providers -- I
20 guess you wouldn't know because you -- okay. You said
21 you're the mental health supervisor for two schools on
22 Oahu?
23 A. Two school complexes, all of the schools
24 within the Kaimuki complex and all of the schools within
25 the Kaiser complex.
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1 Q. How many supervisors are there with DOH
2 providing similar services like yourself?
3 A. There are three of us.
4 Q. So, for the --
5 A. And we have school complexes divided amongst
6 us.
7 Q. So, for the supervisor who is providing
8 services for the Maui complex, is that the only complex
9 that supervisor is responsible for?
10 A. I am not privy to how they work on the
11 neighbor islands.
12 Q. Okay.
13 A. But I can speak for Honolulu Family Guidance
14 Center.
15 SENATOR BUEN: Okay. Thank you.
16 CO-CHAIR SENATOR HANABUSA: Thank you,
17 Senator Buen. Representative Ito followed by
18 Representative Kawakami.
19 REPRESENTATIVE ITO: Thank you, Madam
20 Co-Chair.
21 EXAMINATION
22 BY REPRESENTATIVE ITO:
23 Q. Dr. Gardiner, you mentioned the menu of
24 services, you know, that has a list of providers; and
25 you said that, you know -- well, I just want to ask you:
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1 Is it updated every year or you know --
2 A. Currently the one we have is being updated.
3 It isn't updated as of today, but I do understand that
4 that -- because of the transition in services to the DOE
5 to school-based services, that that manual is being
6 updated because those services will automatically --
7 many of them for low-end services will be going to the
8 DOE.
9 Q. So, the manual right now is out-dated?
10 A. It is out-dated.
11 Q. Okay. Also, I just wanted to ask you another
12 question. You know, the faculty of that Loveland
13 Academy, do you know if they're former Department of
14 Health employees?
15 A. I doubt it seriously. Loveland Academy is a
16 private facility.
17 Q. And what -- where did they get those
18 professors or experts?
19 A. I am not privy to that information. I don't
20 know.
21 REPRESENTATIVE ITO: Okay. Okay. Thank you
22 very much.
23 THE WITNESS: Uh-huh.
24 CO-CHAIR SENATOR HANABUSA: Thank you,
25 Representative Ito. Representative Kawakami followed by
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1 Representative Leong.
2 REPRESENTATIVE KAWAKAMI: Thank you very
3 much, Co-Chair Hanabusa.
4 EXAMINATION
5 BY REPRESENTATIVE KAWAKAMI:
6 Q. I just want to ask this question: When the
7 program very -- started very early back in the 19 --
8 what, '94, one of the questions I had asked was: At
9 what point do you exit children from a program like
10 this? There was no answer. And we're finding -- I
11 think there are some children that could be, and maybe
12 that's the problem we're seeing in -- we keep billing;
13 and some of the kids may be able to be exited or, as you
14 mentioned, I think down step --
15 A. Step down.
16 Q. -- with lesser services, et cetera. But we
17 keep billing at a certain rate; and I wanted to know, if
18 that's the case, what you were mentioning there, do you
19 see some children that could be exited, could be
20 downgraded?
21 A. I don't -- at this point time with the case
22 loads that I deal with, no, they shouldn't be
23 downgraded; but there should be modifications made to
24 the program or clarifications given to us by Loveland as
25 far as the progress.
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1 No, I would not say any of those cases at
2 Loveland should be downgraded or made low-end services;
3 but to maintain the level, we need more documentation
4 and information and more timely documentation so that,
5 as a treatment team, we can actually see and chart the
6 progress of the child which we are not getting.
7 Q. Okay. You're not getting it. Are you asking
8 for it?
9 A. Yes, ma'am.
10 Q. And how are you asking for it?
11 A. Very point-blank. Can you get your
12 documentation to me on time -- in time and when the time
13 gives you -- it's very pointed.
14 Q. You're doing this with the care coordinators?
15 A. The care coordinator does it first. If I
16 step in, it's because the care coordinator has been
17 unsuccessful.
18 Q. Okay. Then you bump it up?
19 A. I bump it up.
20 Q. Okay. How far do you bump it up?
21 A. The furthest I can bump it up is to my
22 supervisor which is the branch chief, Dr. Drews.
23 Q. Okay. And what does he do? Have you done
24 this?
25 A. Have I bumped it up?
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1 Q. Yes.
2 A. We bumped it up as far as we know that there
3 is an investigation going on and there are dialogues.
4 Yes, he has intervened before in getting the matter
5 taken care of; but that's one instance. We have more
6 than one instance of kids we need progress reports on or
7 information.
8 Q. So, what kind of progress do you get from
9 your branch chief? I mean, are you getting
10 satisfaction? It sounds like not.
11 A. It's out of his hands, really, until this
12 investigation is done. I don't know what he could do.
13 If they're being audited and investigated, you know,
14 what can we do? We can't say don't do this or do that
15 and make a stop in the services for the children. We
16 can't do that --
17 Q. Okay.
18 A. -- until we have definitive evidence.
19 Q. Yeah. So, until that investigation is
20 completed. So, what you're saying is you're just
21 continuing as is?
22 A. It's business as usual.
23 Q. Business as usual?
24 A. Yes, ma'am.
25 Q. Okay. Even if you know that the kid needs --
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1 doesn't need all these services, right?
2 A. Yes, ma'am.
3 Q. Okay. You just continue on until this is
4 done?
5 A. Uh-huh.
6 Q. Okay. The other thing I wanted to ask is:
7 On the IEP, on the review or the revision, et cetera,
8 how often does this occur?
9 A. IEPS are held annually.
10 Q. Okay. If --
11 A. But --
12 Q. If it's tied into the progress the child has
13 made, okay, and he's made good progress, shouldn't that
14 IEP come earlier?
15 A. It can be convened earlier.
16 Q. Okay. Who would call it?
17 A. The parent would call it or the DOE.
18 Q. You don't have a part in it?
19 A. No, I don't call IEPs. That's a different --
20 Q. But if you're monitoring this program and you
21 know it should -- these "X" number of children should be
22 downgraded, et cetera, or -- would you not attempt to
23 get an IEP done earlier?
24 A. The D -- the DOH component of this is the
25 CSP, coordinated service plan, and the mental health
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1 plan. If we're actually seeing children making progress
2 and services being downloaded, then we will tell the DOE
3 that this case -- excuse me -- will be transferred and
4 the service will be bumped to low-end services.
5 Q. Okay.
6 A. But in the case of a child at Loveland, it's
7 very remote that that child will ever go to low-end
8 services.
9 Q. And who hired Loveland?
10 A. I am not privy to that. That was prior to my
11 coming on board.
12 Q. Because you keep saying they're the only show
13 in town; am I right?
14 A. As -- yes.
15 Q. Maybe that's -- that's what we got to check.
16 I mean, are they the only show in town?
17 A. And I could be highly mistaken. From the
18 case loads that I deal with, there's no other person I
19 deal with with those type of services other than
20 Loveland that is on the provider list. Loveland is what
21 I see. If I'm uninformed, then I'll go back; and my
22 branch chief will tell me I've been uninformed. But, to
23 the best of my knowledge, Loveland provides those
24 services.
25 Q. Uh-huh. So, that's the only entity that
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1 was --
2 A. Yes, ma'am.
3 Q. -- submitted as far as you know?
4 A. Yes.
5 Q. Okay. You said the MST, to your knowledge,
6 is geared for juvenile delinquents, those that are
7 defiant types of --
8 A. Oppositional defiant conduct disorder.
9 Q. -- kids and working with them is to improve
10 the family relationship and so forth to bring a better,
11 I guess, homogeneous --
12 A. Yes, ma'am.
13 Q. -- kind of family?
14 Did you find that to be an effective means of
15 working with these youngsters?
16 A. For MST, I have no complaints in that I
17 haven't seen the outcome data; and until I see the
18 outcome data, I really couldn't make a decision on it.
19 And being that I'm so new, we have never had
20 any complaints with MST. My complaints of recent have
21 been with the Continuum and the reason I say the
22 Continuum is those cases are being transferred back to
23 the Family Guidance Center and we're in a transition
24 phase.
25 And so, some of these cases were really
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1 high-end high-maintenance kids. All of a sudden, we're
2 bringing them back into the Family Guidance Center which
3 will bump up stress with care coordinators and will bump
4 up stress with myself if I don't see that adequate
5 documentation and work has been done in order for us to
6 make a smooth transition.
7 REPRESENTATIVE KAWAKAMI: I see. Okay. I
8 guess that's all for now, and I thank you very much.
9 THE WITNESS: Thank you ma'am.
10 REPRESENTATIVE KAWAKAMI: Thank you. Thank
11 you, Co-Chair.
12 CO-CHAIR SENATOR HANABUSA: Thank you,
13 Representative Kawakami. Representative Leong followed
14 by Representative Marumoto.
15 REPRESENTATIVE LEONG: Thank you, Chair.
16 Thank you, Chair Hanabusa.
17 EXAMINATION
18 BY REPRESENTATIVE LEONG:
19 Q. Dr. Gardiner, you've been at Loveland -- I
20 mean, you've been at the DOE now for two months?
21 A. Yes, ma'am.
22 Q. How soon were you aware of some of these
23 abuses of billing?
24 A. Within one week.
25 Q. Within a week. And you've been trying to
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1 investigate these billing errors; is that correct?
2 A. Yes, if not the billing areas, the services
3 provided.
4 Q. Uh-huh.
5 A. I usually won't deal with the money, but I
6 will always deal with the services that are provided.
7 Q. Uh-huh. And now you've been trying very
8 hard -- you've made 17 calls to Loveland Academy and not
9 gotten any results. What else can you do about it?
10 What are you going to do?
11 A. Honestly?
12 Q. Yeah, honestly.
13 A. I will do nothing. I will wait until the
14 investigation comes back, and the branch chief tells me
15 this is our plan of action.
16 I have to pick and choose the battles I can
17 fight. I have 142 children; and if I spend all of my
18 time on Loveland Academy -- and I hate to say this --
19 there will be many other kids that I service that will
20 go undone.
21 And so, I've made my complaint known; and
22 I've made it known without hesitation. And I'm now
23 making it known to you. At this point, I choose not to
24 deal with Loveland Academy because it frustrates me; and
25 when I'm frustrated, my care coordinators are
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1 frustrated. When they are frustrated, all of the other
2 private providers they deal with can tend to get
3 frustrated. Families get frustrated; and the bottom
4 line, the child will suffer in the end.
5 Q. My question to you is that can you tell me
6 right now what is the status of the enrollment at
7 Loveland? Do you have any idea?
8 A. I don't know what the status enrollment, but
9 I can tell you who we deal -- how many kids I'm dealing
10 with. In the day treatment program, we have 14 youth.
11 In the after-school program, we have 22 youth; and of
12 the 22 number, that could be a duplicate because some of
13 them that are in the day treatment also are in the
14 after-school program as well.
15 Q. Uh-huh. When I visited Loveland, I heard
16 some discussion, as we were walking through the campus,
17 that the -- someone said that they thought that so many
18 of the students that were sent there really didn't
19 belong there. They were not -- I mean, they were --
20 they would not have to spend their time there, which
21 would mean that we would not have to bill them for so
22 much. Do you know about that?
23 A. I would only say this: In Loveland's wisdom,
24 if they know that the child was inappropriately placed,
25 then they should have called back to the Family Guidance
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1 Center to the care coordinators and saying, "We're not
2 seeing that those services are needed."
3 Q. But that hasn't happened?
4 A. Not to my knowledge on any of the cases that
5 I supervise.
6 REPRESENTATIVE LEONG: All right. Thank you,
7 Dr. Gardiner. Thank you, Chair.
8 CO-CHAIR SENATOR HANABUSA: Thank you,
9 Representative Leong. Representative Marumoto followed
10 by Co-Chair Saiki.
11 REPRESENTATIVE MARUMOTO: Dr. Gardiner, I
12 just want to thank you for your candor.
13 THE WITNESS: Thank you.
14 REPRESENTATIVE MARUMOTO: Madam Chairman, I
15 have no questions.
16 CO-CHAIR SENATOR HANABUSA: Thank you.
17 Representative Saiki?
18 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
19 EXAMINATION
20 BY CO-CHAIR REPRESENTATIVE SAIKI:
21 Q. Dr. Gardiner, I just have a few questions.
22 First, on the service authorization process --
23 A. Yes, sir.
24 Q. -- you had mentioned that the more intense --
25 intensive the service, then authorization was required
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1 by the branch chief?
2 A. Yes.
3 Q. But prior to the authorization going to the
4 branch chief, was there ever an opportunity for staff to
5 evaluate the request for the service before it went to
6 the branch chief?
7 A. Usually before the branch chief was involved
8 in the process, they went through clinical services; and
9 that's CAMHD division. And they would look at whatever
10 was being prescribed, the length of time for a partial
11 hospitalization, how long it was going to be; and they
12 would kick it back to us with questions questioning why
13 do we need this amount of time and how long the
14 duration. And the form itself actually would -- you
15 would have to list the length of time; and that length
16 of time translated into dollars, dollars and cents.
17 And so, it was the job of the division. Now,
18 that the branch chief and the clinical director has it,
19 as a clinician, I see that as a plus because sometimes
20 division was kind of slow in giving us the turn-around.
21 And if you have a child that has to be hospitalized, you
22 can't be waiting for someone downstairs to give you an
23 answer. Whereas, now, in the branch with the clinical
24 director and the branch chief, we get a faster
25 turn-around.
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1 And I will say to the merit of having a
2 clinical director and the branch chief, they do
3 scrutinize and ask a lot of questions of: Why do you
4 want to place this child in the hospital? Why are you
5 spending this? They do ask the dollars and cents
6 questions from us. It translates into that, but they
7 balance that. What is the best need for the child at
8 this time?
9 Q. Okay. More specifically, was -- did Loveland
10 fall into this category of services that required
11 authorization of the branch chief?
12 A. No.
13 Q. Okay. So, who could authorize services from
14 Loveland?
15 A. If it was within the IEP and we felt a child
16 needed to go to Loveland Academy, I could sign off.
17 Q. Did you always sign off?
18 A. In the two months I've been here, I've sent
19 no one to Loveland. I've signed off on nothing for
20 Loveland. I'm just doing maintenance of what already
21 was at Loveland.
22 Q. Well, was there ever a situation where
23 somebody at your level or someone with the authority to
24 sign off on services refused to recommend or to
25 authorize services to Loveland?
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1 A. I wouldn't say they were refused; but there
2 has been a reluctance to want to send someone to
3 Loveland because some of the basic things I described,
4 wanting some answers. That's all we want is some
5 answers. And it would make it easier in your conscience
6 as a clinician to say, "Okay. I don't have a problem
7 with this child being here" or the services that are
8 being performed. It's the lack of communication.
9 Q. Well, was there ever a situation where senior
10 management at the health department ordered services to
11 be provided through Loveland over the objections of
12 staff?
13 A. Not that I'm aware of.
14 Q. You had mentioned that there are
15 approximately 14 day students and maybe 22 --
16 A. There are 14 in the day treatment program and
17 22 in the after-school program.
18 Q. Do you know what the -- well, does Loveland
19 charge tuition; or how does it -- how does Loveland
20 charge for services?
21 A. I'm really not privy to that. I just look at
22 what the services they perform and if it's needed by
23 the -- the treatment team sees that it is a need, then I
24 go by the services. And I'll ask the branch chief
25 division -- the PHAO handled fiscal matters. It
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1 keeps -- at least, it keeps my integrity intact. When
2 I'm talking to a parent, I'm not talking dollars and
3 cents. I'm talking about their child.
4 Q. So, you're not sure if there's a tuition
5 that -- an overall set tuition that is charged?
6 A. I'm not sure. I'm not sure how the contract
7 is set up. And I purposely choose to not want to know.
8 Not unless the branch chief wants to bring it to my
9 attention or question me, I try not to know. It is a
10 very fine line I walk when I have to deal with parents
11 and providers and what's best for the child.
12 Q. Okay. You had mentioned that when you review
13 some of the progress reports, that it appears that the
14 reports are basically cut and paste and --
15 A. Yes.
16 Q. -- that standard language is used in the
17 progress reports. Have you ever raised that or made a
18 complaint about that?
19 A. I did. And that was six of the 17 phone
20 calls. I wanted to understand the process of how
21 progress notes were written, and I have gotten no
22 response.
23 Q. And those were phone calls made to Maggie
24 Koven?
25 A. Yes.
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1 Q. But you've never met her or talked to her?
2 A. Not to this date.
3 Q. Do you know if there's actually a
4 person that -- do you know whether Maggie Koven actually
5 exists?
6 A. Yes, she does.
7 Q. I just wanted to make sure.
8 A. I would not swear my life on it because I've
9 only seen her signature, but I do have people who know
10 that she does exist.
11 Q. Okay. Thank you very much. I believe she's
12 on our Subpoena list. So, we'll have an opportunity to
13 check -- verify that.
14 So, aside from the six of the 17 phone calls,
15 did you make any other complaints about the progress
16 reports to anyone else?
17 A. It's -- it was very hard for me to make
18 complaints other than -- because she is a credentialed
19 person, I consider her a co-colleague of mine. We're on
20 the same level; and it would have been -- to me, I don't
21 like going around the corner.
22 She was the one signing. Then I needed to
23 hear from her; and because it's almost virtually
24 impossible to get a phone call answered, all I could do
25 was document and raise the concern to my branch chief
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1 who then told us that an investigation was going on.
2 And after that was said to me, I just let it drop until
3 I hear something other.
4 CO-CHAIR REPRESENTATIVE SAIKI: Okay. Thank
5 you very much, Dr. Gardiner.
6 CO-CHAIR SENATOR HANABUSA: Thank you.
7 EXAMINATION
8 BY CO-CHAIR SENATOR HANABUSA:
9 Q. Dr. Gardiner, let me understand something.
10 You said there are 142 active cases under, if I can use
11 the word, your jurisdiction?
12 A. Uh-huh.
13 Q. Can you tell us what, I guess, qualifies a
14 case or a student to be under your particular
15 jurisdiction?
16 A. The Department of Health, along with the
17 Department of Education -- the Department of Education
18 takes low-end services kids, kids that can get
19 outpatient services.
20 By the time they get to the Department of
21 Health, a diagnosis is such that intensive in-home
22 services are needed. The level of medication management
23 may be needed. The care -- they're high-end services
24 and the high-end autistic kids remain with the
25 Department of Health.
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1 Q. Okay. So, the high-end autistic kids are the
2 142?
3 A. Those and we do have some that are not --
4 that don't fit into that diagnosis or category, but they
5 are special ed.
6 Q. And they require special types of services?
7 A. Services, yes, ma'am.
8 Q. Now, other than Loveland -- you said it's 14
9 day, 22 after-school care; and the 22 may actually
10 include the 14. What other providers do you use besides
11 Loveland?
12 A. There are an array of providers. When it
13 comes to TAs, there are several agencies that are
14 contracted with the Department of Health; and we have a
15 cadre that we use from -- right now in the State of
16 Hawaii, TAs are a commodity. When we get them, we try
17 to hold on to them because there is a shortage in the
18 state.
19 And so, we try to use those who have been
20 tried and true and worked with us in the past; and you
21 find out, as that number increases with children, case
22 loads, TAs are spread kind of thin. And so, there are
23 several agencies that have TAs that we use.
24 Q. Would it be a correct statement to say that
25 each of the 142 cases would have a TA?
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1 A. No.
2 Q. So, about how many TAs do you have under
3 your control?
4 A. I would say -- of my 142 cases, I would say
5 130-something have TAs and some with multiple TAs.
6 Q. And the ones who do not, which may be about
7 12 or so --
8 A. Uh-huh.
9 Q. -- why would they not qualify for TAs?
10 A. They were in MST -- MST Continuum.
11 Q. So, they may have TAs; but they haven't been
12 assigned one yet when they came back to you?
13 A. Not all of the MST Continuum cases have come
14 back; and so, I'm in the process of looking at what will
15 come back to me and what will be needed.
16 And so, when the cases go MST and MST
17 Continuum, I just don't deal with it because it's their
18 program. Let them deal with it, not unless they need to
19 corroborate and get more information before the file was
20 turned over to them.
21 Q. Have you ever observed the MST -- the home
22 care or the other category of the MST that we've heard
23 testimony on?
24 A. Just the MST in home.
25 Q. In home, home based. I'm sorry.
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1 A. No, I haven't observed.
2 Q. But, in your mind, there's a difference
3 between the Continuum and the home based -- is the word
4 that they used?
5 A. Yes.
6 Q. Do the home-based MST children also come to
7 you or have come -- transferred to you or is it only the
8 Continuum?
9 A. When a child is put in MST -- MST, they are
10 not with me. They are in MST.
11 Q. Okay.
12 A. And they are managing the case. For whatever
13 reasons, sometimes -- and I'm speaking strictly now
14 about the Continuum -- I will be dealing back with the
15 Continuum cases; and those are really high-end -- some
16 hard cases.
17 Q. You said that one of the reasons why you do
18 not want to know about the costs is basically because
19 when you speak to a parent, you want to just talk about
20 the child and you don't want to be bothered about the
21 costs of providing it?
22 A. Yes.
23 Q. Have you had the opportunity to review
24 Loveland's contract with the Department of Health?
25 A. No, I haven't. And may I clarify something?
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1 Q. Sure.
2 A. When I say -- when I'm speaking to a parent,
3 we speak oftentimes about families in deficits, that
4 this family has this problem, this problem, this
5 problem.
6 When I speak to a family, I speak from a
7 strength base, the good things about the family.
8 Because before the Department of Health came along and
9 before all of us came along to be the great helping
10 hand, somehow families were resistent and they were
11 managing.
12 And so, when I talk to a family, I don't
13 always like to remind them that there are so many
14 deficits. I like to build on some of the positive
15 things they have done, and sometimes it becomes a burden
16 to a family to hear that they're being relegated to --
17 Oh, I'm sorry, we can't help you here because it costs
18 this and that.
19 Now, when I talk to care coordinators, I am
20 savvy about costs; but when I'm talking to parents and
21 providers and it's dealing at an IEP, I stay away from
22 that. Let's argue that somewhere else. I don't want to
23 deal with that with a family.
24 And that's an ethical dilemma with me because
25 I wouldn't want anyone to come to me and talk -- if I
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1 had a child -- and start talking about my child, that he
2 was in terms of the dollars and cents worth to the
3 Department of Health. That would demean the whole
4 process; and to me, it would make that family feel that
5 they're at the mercy of dollars and cents of a system.
6 Yet, I think parents know that there is a
7 cost factor involved; and they're quick enough to tell
8 us when services aren't being provided.
9 Q. Okay. Do you participate in the IEP process?
10 A. I go when things are boiling to a point and
11 sometimes I go because the case has an interest to me
12 and I proactively see that down the road it's going to
13 need more intensive case management.
14 Q. You made a comment about Loveland Academy and
15 the problem is: Where else do you find that kind of a
16 service, even with all the reservations that you have
17 about them? When you say "that kind of a service,"
18 what's the unique service that Loveland is providing?
19 A. If you have a high-end autistic child,
20 putting them in a regular DOE self-contained classroom
21 may not meet the bill, especially if you have several
22 other high-end autistic kids.
23 To manage a high-end autistic kid is a work
24 of art. It's a work of mercy. It's a work of grace,
25 and I'm not going to downplay it. The people who work
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1 with them have to have some kind of higher calling other
2 than a paycheck. These kids can drain your energy.
3 They drain your time. And so, you have to have some
4 type of special training and know-how to deal with
5 high-end autistic kids.
6 How the parents deal with it -- you know, I
7 would like to go back to the issue -- if you could ask
8 me the question about respite because I felt it was
9 unfairly dealt with when you're dealing with high-end
10 kids.
11 If you want me to testify, I would rather be
12 honest with you and give you the whole spiel and give
13 you -- instead of giving you half of the spiel. Because
14 if you're dealing with a high-end autistic kids -- and
15 some of these families have more than one child that has
16 special needs.
17 If the family becomes -- the parents become
18 so dysfunctional or so to the point where they cannot
19 manage what's in that household, we're looking at
20 out-of-home placement; and once you divide up the home,
21 the statistics says that it's almost likely it's going
22 to be very hard to get that child placed back into that
23 home. We've broken up a family. I don't want that on
24 my conscious. I want to use the least restrictive
25 intervention to keep a family together.
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1 And so, when a child goes to Loveland, of
2 a -- in and of itself, it is a respite for us -- for the
3 parents. If you have to deal with the -- some of these
4 kids can't even go to the bathroom on their own. If
5 you've never done that type of work, you don't know what
6 it's like. I can't even explain it to you.
7 I have a col -- I'm supposed to be getting a
8 colostomy because I can't hold my own. I can only
9 imagine what that will mean for me and -- but, yet,
10 we're dealing with a child in those circumstances.
11 And sometimes when respite is given, it's not
12 given so people can baby-sit children. I have a strong
13 aversion to calling respite just baby-sitting. It is
14 not about baby-sitting from a true clinician's
15 perspective. It's about giving a mental health break
16 from the parents who have the day-to-day oversight of
17 that child.
18 And sometimes if we don't give them that
19 break, then we have another problem. The father may
20 choose to book and leave. Then we have a single parent
21 we're dealing with.
22 There are some justifications why respite
23 care is given. It's not just an all-in-one, here, take
24 this; and we're going to provide you with someone to sit
25 and hold hands with your child while you go shopping.
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1 Yes, they may go shopping; but the bigger picture is
2 they need a break from dealing with such an intensive
3 situation with their child.
4 Q. And you're saying that -- we were talking
5 about the MST Continuum children.
6 A. Uh-huh.
7 Q. And you're saying the MST Continuum children,
8 in your opinion, is equivalent to the autistic children
9 that Loveland is dealing with?
10 A. There's some high-end cases that we're going
11 to be dealing with, some oppositional defiant cases that
12 will require heavy intense supervision and case
13 management.
14 Q. And the situation in the 142 -- do you also
15 believe that they are primarily -- or 50 percent of them
16 or more may be in foster care so that the family unit
17 itself may not be there; but they're, in fact, in foster
18 care?
19 A. I do not have those statistics, and I was --
20 that was my first time hearing that today.
21 Q. Okay. Now, let me ask you another thing that
22 you testified to regarding the Loveland Academy. You
23 said you made the complaint and then you were told that
24 there is going to be an audit and you were also told
25 that there was an audit prior to this.
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1 Do you know how long -- the first question
2 is: Do you know how long Loveland has had its contract
3 with the Department of Health?
4 A. No, ma'am, I don't.
5 Q. So, you don't know how many other audits may
6 or may not have been done?
7 A. No, ma'am, I don't.
8 Q. And you have no idea what kind of audit CAMHD
9 is performing at this point time?
10 A. I understand it's a fiscal audit.
11 Q. Have you been consulted or asked to provide
12 input as to what kinds of information should be looked
13 at?
14 A. Yes, ma'am, I have been.
15 Q. Okay. And what have you said that you would
16 like to see them audit?
17 A. I would like to look at the duplication of
18 services where they provide a TA and, yet, we have to
19 add another TA to a part of the program. Why are we
20 double billing, or why are we paying for double
21 services --
22 Q. Okay.
23 A. -- if they're an all-inclusive program?
24 Q. Is there any other kind of fiscal types of
25 things that you came across in your period of time that
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1 you were looking at Loveland that you also brought to
2 the attention of CAMHD in doing their audit besides this
3 double billing of services, any other things?
4 A. The other things would be programmatic in how
5 they go about doing their charting and maintaining a
6 clinical chart; whereas, that would be of greater
7 interest to me as a clinician to be able to have access
8 to see how things are being done.
9 Q. At any time with the concerns that you
10 raised, did CAMHD or its contract administrator, whoever
11 is doing this audit, ever tell you, "I'm sorry,
12 Dr. Gardiner, that's outside the scope of their contract
13 or that's not something we can ask them"? Were you
14 given any kind of sort of, you know, limitation to what
15 they would or could do in terms of performing their
16 audit?
17 A. To their credit, there were no limitations.
18 They just said give it to us straight.
19 Q. And who was it that you spoke to at CAMHD?
20 A. David Drews. He is the branch chief; and he
21 takes all of our complaints, cries, moanings, and
22 groanings.
23 Q. And when did Mr. Drews tell you that there
24 would be this audit performed?
25 A. It was brought up about three weeks ago that
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1 it was an audit; and the reason for that, we were
2 planning on bringing Dr. Koven in and Loveland in and
3 just having a face-to-face talk. We were at a level
4 where we were so frustrated, that we wanted something to
5 happen.
6 And he said to us, "Before I call them in, I
7 need to check with division to make sure that there
8 isn't anything else going on." Then he did come back to
9 us in the next management meeting and says that it would
10 not be in our best interest to interfere with an ongoing
11 investigation that division had already begun on
12 Loveland Academy.
13 Q. Were you given a time frame as to when they
14 expected to complete this investigation?
15 A. No, ma'am.
16 Q. The other question I had was -- and I believe
17 a valid point that you make regarding some sort of
18 review process or a benchmark and a systematic
19 reappraisal of the situation. As far as you know, is
20 there anything like that built into the system as it
21 presently stands?
22 A. The IEP should be the benchmark of success
23 and failures.
24 Q. Right.
25 A. But when it's not generated along a period of
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1 time -- I don't want to wait for one year to find out if
2 the kid has succeeded or failed. I would like those
3 quarterly reports sent in on time so we can accurately
4 assess if the services should continue. The problem is
5 the quarterlies don't come in on time or they don't come
6 in at all.
7 Q. So, what's your experience in terms of these
8 reports? If they don't come in quarterly or they don't
9 come in at all, is that like you haven't seen any in the
10 file or are they once a year or once every two years?
11 A. Well, when they do come, they come all in a
12 bunch; but the problem with that is that I have no
13 monitoring tool. And so, the care -- we can't just cut
14 a service because I have no documentation to cut.
15 And so, it's -- you're damned if you do and
16 you're damned if you don't. So, I have to continue to
17 let the service keep going; and that's frustrating to me
18 because I don't know where the child is and I can't
19 honestly talk to a parent about where a child is with
20 Loveland if Loveland hasn't told me where that child is.
21 Q. This quarterly report or this stack of
22 reports that you get, is that the one you testified to
23 before regarding the fact that Ms. Kov -- Dr. Koven
24 seems to sign the same thing --
25 A. Yes, ma'am.
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1 Q. -- there may be a couple of words changed?
2 And you've had the opportunity to review some
3 of your -- the 140 -- well, maybe not the 140, maybe
4 just 22.
5 A. All of them.
6 Q. You reviewed all of them?
7 A. I review all of my cases.
8 Q. Over a period of time?
9 A. Yes.
10 Q. So, you found in those files the same thing?
11 A. Yes.
12 Q. Can you just give me, as an estimate, for
13 some of the students that you've reviewed, how long
14 they've been at Loveland?
15 A. Some, two -- two years; some, 18 months;
16 some, 12 months; some, six months. And that's about the
17 range.
18 CO-CHAIR SENATOR HANABUSA: Thank you,
19 Dr. Gardiner. I have nothing further. I'll just check
20 if there's any redirect from --
21 SPECIAL COUNSEL KAWASHIMA: None. Thank you.
22 CO-CHAIR SENATOR HANABUSA: Any other
23 questions from any of the members of the Committee?
24 Thank you very much.
25 THE WITNESS: Thank you very much.
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1 CO-CHAIR SENATOR HANABUSA: Members, we've
2 been going for a while now; and we will take a short
3 ten-minute recess and reconvene at -- hopefully,
4 everyone, at 2:37. Thank you.
5 (Recess from 2:28 p.m. to 2:45 p.m.)
6 CO-CHAIR REPRESENTATIVE SAIKI: Members, we
7 would like to reconvene our hearing; and our last
8 witness for the day is Michael Stewart. Is Mr. Stewart
9 here? Please, have a seat. We'll administer the oath
10 at this time.
11 CO-CHAIR SENATOR HANABUSA: Mr. Stewart, do
12 you solemnly swear or affirm that the testimony you are
13 about to give will be the truth, the whole truth, and
14 nothing but the truth?
15 MICHAEL STEWART: I do.
16 CO-CHAIR SENATOR HANABUSA: Okay.
17 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
18 Mr. Stewart. Mr. Kawashima will proceed at this point.
19 EXAMINATION
20 BY SPECIAL COUNSEL KAWASHIMA:
21 Q. Please state your name and business address.
22 A. Yes. My name is Michael Stewart. The thing
23 is I work at the Diamond Head branch of the Family
24 Guidance Center of the Department of Health.
25 CO-CHAIR REPRESENTATIVE SAIKI: I'm sorry.
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1 Mr. Stewart, could you please pull the mike forward a
2 little bit?
3 SPECIAL COUNSEL KAWASHIMA: Closer to you.
4 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
5 THE WITNESS: Sure.
6 Q. (BY SPECIAL COUNSEL KAWASHIMA) And what is
7 your position, sir, at the Diamond Head Family Guidance
8 Center?
9 A. I'm a Social Worker 4, but I act as a care
10 coordinator.
11 Q. Care coordinator?
12 A. Yes.
13 Q. Just briefly, sir, will you give us your
14 educational background?
15 A. I have a bachelor of arts from Western
16 Washington University in sociology, and I did graduate
17 studies there.
18 Q. And what about your work experience, sir?
19 A. It is -- for the last 12 years, I've worked
20 as a social worker for the State of Hawaii.
21 Q. And is that a social worker with the
22 Department of Health?
23 A. Four years -- the last fours years with CAMHD
24 division. Before that, I worked for the Department of
25 Human Services for foster care for a year; before that,
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1 four years as a social worker with the developmental
2 disabilities division; and before that, about four years
3 with CPS.
4 Q. Thank you. So, how long have you been with
5 the Department of Health Family Guidance Center?
6 A. Four years this October 1st.
7 Q. And who is your supervisor, sir?
8 A. Dr. Kenneth Gardiner.
9 Q. He was the gentleman that testified just
10 before you?
11 A. Yes, sir.
12 Q. And who is the head of the Diamond Head
13 Family Guidance Center?
14 A. David Drews.
15 Q. And what are your general responsibilities
16 with the Department of Health Diamond Head Family
17 Guidance Center?
18 A. I manage a caseload on the Kaimuki complex.
19 Principally what I have is elementary schools. I have a
20 caseload between -- fluctuates between 15 and 20.
21 Q. And you provide academically relevant mental
22 health services --
23 A. That's the goal.
24 Q. -- to children under the IDEA and the -- what
25 they call Section 504 of the Rehab Act?
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1 A. That's correct.
2 Q. Is that what you do?
3 Now, can you then tell us what your duties
4 and responsibilities, though, more specifically are in
5 terms of caring for these types of children?
6 A. Yes. Once a child is identified as being
7 eligible for those services either under IDEA or 504, I
8 begin by attending meetings which the Department of
9 Education has, which is the IEP, generally. I also
10 usually facilitate a coordinated service plan and am at
11 least consulted on the mental health treatment plan.
12 From these plans, I procure services to be able to meet
13 the needs of the children and the team to help the
14 children.
15 Q. Do you monitor them also?
16 A. Yes, I do.
17 Q. Now, so, what kind -- what kinds of plans are
18 there that you're responsible for monitoring?
19 A. Well, the IEP plan, I have -- really it's the
20 mental health insert. What it is is a related service
21 that the department has contracted at the IEP. I
22 monitor that part, not the educational part.
23 And the CSP -- mainly it's a communication
24 tool to make sure all parties understand what we're
25 doing with the child. The treatment plan is the one
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1 that the providers have to work with me on.
2 Q. The mental health treatment plan?
3 A. Or service plan it's called, either one.
4 Q. Now, will you explain to us your
5 understanding, sir, of what an IEP is then?
6 A. An IEP is a meeting that's held to secure
7 whatever is necessary to overcome this child's barrier
8 to get an education.
9 Q. And that IEP is developed with a number of
10 different, you know -- I should say, people from
11 different disciplines?
12 A. As needed.
13 Q. Now, you mentioned one of your duties was to
14 provide -- procure services for children. How do you do
15 that?
16 A. Well, at the -- if you -- the coordinator
17 will ask at the IEP meeting if anyone has a track record
18 or, you know, prefers an agency that we work with for
19 one reason or the other because they do have different
20 philosophies. If that's not the case, then when I get
21 back to the office, I usually assign it according to,
22 one, my familiarity with the agency and, two, what the
23 market is, who's got the available people.
24 Q. What happens after that in terms of the
25 agency being involved or becoming involved?
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1 A. Well, once the agency tells me they can
2 provide the service, then I fill out a service
3 authorization. Most levels of service I can authorize
4 myself, so long, of course, I'm following the plan, the
5 IEP and the treatment plan. There's a few services,
6 respite and flex and TA services, that I would have to
7 get a superior to authorize.
8 Q. Why is that, sir?
9 A. I guess because -- in respite and flex, I
10 suspect because they're unstructured noncontracted
11 services that they want to have a higher review. When
12 it comes to the TAs, I'm not certain of the full
13 rationale.
14 Q. All right. So, how many children does the
15 Diamond Head Family Guidance Center service?
16 A. I think around somewhere between 3 and 400,
17 around 350 children, I think.
18 Q. Now, I understand they're divided into a
19 Honolulu branch and a Diamond Head branch?
20 A. Kalihi-Palama unit and Diamond Head unit
21 which, I think, together is the Honolulu branch.
22 Q. And how many are there in those two
23 facilities?
24 A. Well, we've got four complexes at Diamond
25 Head; and we've got two at Kalihi-Palama. So, I think
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1 it's about a third/two-thirds kind of share.
2 Q. So, Diamond Head has 200 of them about?
3 A. I would think.
4 Q. And the rest come from Kalihi-Palama?
5 A. I would think so.
6 Q. How many care coordinators like you are there
7 at the Diamond Head Family Guidance Center?
8 A. I believe around 17, 18, something like that.
9 Q. I think you mentioned your caseload earlier,
10 sir. I didn't note it. What is your typical caseload?
11 A. Mine is between 15 and 20.
12 Q. Now, as a care coordinator, then, you get
13 quite involved with the children, do you not?
14 A. Certainly.
15 Q. Are you aware of the services that are
16 provided for the children on -- that are in your
17 caseload?
18 A. Yes, I am.
19 Q. Tell us what -- describe the types of
20 services that are typically -- typically provided for
21 for these children with mental health needs.
22 A. Well -- okay. I -- since the majority of my
23 cases are still autistic cases and I still provide the
24 full range as we used to, that range would be:
25 Emergency services if a child had to be transported
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1 somewhere; evaluation services, including psychological
2 and psychiatric; therapy, group, individual and family
3 therapy. Also, we pay for medication monitoring, for
4 courtroom and IEP participation, for intensive in-home
5 services, for school consultation, for therapeutic
6 aides, and biopsychosocial programs. And most above
7 that is institutional kind of services.
8 Q. All right. Now, without naming names, sir,
9 without getting -- or giving us the names of particular
10 cases -- we'll keep that for now a matter -- a private
11 matter -- are you aware of instances, in your opinion,
12 where there has been excessive spending?
13 A. Yes.
14 Q. Tell us what areas they are, sir.
15 A. Well, in -- I guess one thing is that with
16 the biopsychosocial programs, it doesn't seem we're able
17 to get a child in there without having to also put a TA
18 in for one-on-one support. And that's not my
19 understanding of how it was envisioned, but that turns
20 out to be the reality if you want to get a child into
21 one of those programs.
22 I see -- in school consultation, I've had
23 cases where I've had to challenge it because I just
24 couldn't believe that the therapist was spending that
25 much -- common sense was the problem. It was that I
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1 couldn't believe the therapist was spending that much
2 time with the educators. Excuse me. And it turned out
3 they weren't, and I was able to reduce it.
4 I've seen intensive in-home services that
5 have existed for so long -- the thing is I think they're
6 at -- really having an opposite effect of what it was
7 they were even intended for.
8 So, I would say those are probably the -- and
9 the medication monitoring, from my understanding from
10 both my present and my former clinical director, for
11 them to be seen by a psychiatrist or neurologist once a
12 month is really overkill. The patient -- and it also
13 cuts the family doctor out of the loop because the thing
14 is they should be the ones that are providing that kind
15 of monitoring, for the most part. So, those are areas
16 I've seen.
17 Q. Thank you, sir. You -- if I might develop
18 these four -- I think you developed four areas for us.
19 One had to do with the use of therapeutic aides.
20 Another was in-school consultation. Another was
21 medication monitoring; and I think the last area you
22 discussed was intensive home care services, in that --
23 somewhat in that order.
24 A. Okay.
25 Q. Am I correct that those are four areas you've
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1 identified?
2 A. Those are four areas I identified.
3 Q. Now, the use of therapeutic aides, though,
4 what do these aides do?
5 A. Well, the aides do a tremendous amount is --
6 you know, and thank God we have them. We don't have
7 enough, and we don't have enough qualified ones.
8 What they do is one-on-one work with
9 children -- with my children, autistic children, they
10 have to do very progressive kinds of therapy, card
11 therapy. They can do picture therapy, things that
12 require constant prompt and constant -- and every five
13 minutes, you've got to be prompting the child; and it
14 can wear you out. That's why some children have to have
15 multiple TAs, not because the assignment is that broad;
16 but the thing is you can't do that to any individual.
17 You can't make them do that for 40 hours.
18 The problem with the TAs, though, is that we
19 don't have enough of them so that the care coordinators
20 are pretty much held hostage by the agencies as far
21 as -- in working with them because the fastest way a
22 case can go down is for the one-on-one support not to
23 show up. The thing is they really got you.
24 Q. They --
25 A. Oh, yeah, they'll call you up and say they
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1 want an authorization right now. I'm not saying that
2 there's not one called for; but, I mean, even if it's
3 late, the thing is that the threat is the personnel will
4 not show up to service the child, which I've always
5 thought was clinically, you know, abhorrent. And I've
6 tried to make that point clear.
7 But the part about the TAs is that the
8 agencies aren't giving me, as a coordinator, not very
9 much is -- in the four years I've been out there, I've
10 never seen a supervisor from one of those agencies ever
11 observing one of these TAs to see what it is that they
12 were supposed to be doing.
13 And when it comes to getting a plan from them
14 to follow along with the plan with the therapist, it's
15 very hard to get a hold of them. So, I've often
16 wondered -- and, yet, I am aware after all these years
17 that the thing is the agencies through our contract are
18 very well compensated for training and clinically
19 supporting and supervising these TAs; but I don't think
20 we get it.
21 Q. Well, let me develop that for a few minutes,
22 sir. "They're very well compensated," what do you mean
23 by that?
24 A. Well, I mean, the thing is is -- well, you
25 know, I'm not a contractor nor am I a business analyst;
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1 but the thing is that from what I've been privy to -- we
2 used to have those numbers in front of us -- they get
3 darn near a third of the total of the costs that we per
4 hour price it out.
5 So, it's one of those things where the TA --
6 the most they get is 15 bucks. They get, like, 9, 12,
7 or $15; and, yet, the agency gets 20-something -- I
8 don't know. $25, I'm sure, is not really an
9 exaggeration per hour. So, it seems like a lot of money
10 per hour considering I've never seen anyone even
11 supervise them.
12 Q. I've heard 30-plus dollars.
13 A. I'm trying not to exaggerate.
14 Q. By the way, let's identify who we're talking
15 about. We say "agencies." We've been using that term.
16 A. Right.
17 Q. Give us an example of what you're talking --
18 who you're talking about.
19 A. Hawaii Behavioral Health, TIFE.
20 Q. TIFE, T-I-F-E?
21 A. T-I -- I'm sorry, sir. It is The Institute
22 for Family Enrichment, TIFE; CARE, which is Child and
23 Adolescent Resources for Education; CFS, which is Child
24 Family Services; Catholic Charities, to name a few.
25 Q. Are these essentially nonprofits?
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1 A. I'm not aware of their tax status.
2 Q. Now -- so, you're saying that these
3 agencies -- these type of agencies -- and you've
4 identified some. There are more, of course, right?
5 A. Those are the biggies.
6 Q. And they provide the personnel, in other
7 words?
8 A. Yes.
9 Q. And they charge the State of Hawaii, through
10 the Department of Health, a certain amount per hour for
11 each one of those aides?
12 A. Yes.
13 Q. And you're saying they're charging at least
14 $30 an hour for each one of those aides?
15 A. No, you said that.
16 Q. All right. You said it might be 25?
17 A. Yes.
18 Q. Being conservative?
19 A. Correct.
20 Q. All right. But then they turn around and pay
21 these aides much less than that?
22 A. Yes.
23 Q. And they're supposed to train and supervise
24 these aides, though?
25 A. Yes.
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1 Q. And you've never seen anyone from the
2 agencies at any time on campus supervising these people?
3 A. True.
4 Q. And how about training them? Do they train
5 them?
6 A. I believe they have training, but the level
7 of training or the how they do it doesn't keep up with
8 the real quality of the personnel that ends up being
9 assigned.
10 Q. So, who ends up then, sir, providing this
11 training?
12 A. Our therapists who are paid through school
13 consultation or try to get us to increase their therapy
14 hours to be able to make this work.
15 Q. In essence, you end up paying for the
16 training of these people who should be independently
17 trained?
18 A. Yes, sir.
19 Q. Is that what you're saying?
20 A. Yes, sir.
21 Q. Have you raised this with anyone?
22 A. Yes.
23 Q. With whom?
24 A. With my direct supervisor. And I believe
25 that this is a commonly known flaw in the production of
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1 services; but considering that we are so dependent upon
2 them to keep these cases stable and active, I don't know
3 what --
4 Q. Have you brought it to the attention of
5 anyone else?
6 A. I brought it to the attention of the agencies
7 themselves. And the thing is I hear about -- I hear
8 these complaints, you see, from the TAs themselves.
9 I guess I kind of see myself on their side in
10 this -- is that they don't feel they -- you know, they
11 want this support. I mean, if you were working with a
12 challenging child, the thing is, of course, you want
13 people to come down and help you.
14 And the thing -- and it turns out who has to
15 help them is the good therapists that I have on my
16 cases, but it turns out I have to compensate them for
17 something that's not being done by the agency. I mean,
18 I can understand a little bit of give and take on that,
19 sir, you know.
20 Q. Sure.
21 A. The thing is I don't see it as a little bit
22 of give and take.
23 Q. From what you see, though, sir, would it be
24 more cost efficient cost effective for the state to
25 directly contract little these therapeutic aides and cut
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1 out that middle person?
2 A. Yes, sir.
3 Q. How about school consultation? I didn't
4 quite understand what you meant there about having this
5 one-on-one --
6 A. School consultation is supposed to be for the
7 educators. If the educators, our teachers, have what
8 they call district level support, they have resource
9 teachers that teach them how to take care of kids with
10 learning disabilities and stuff like that, educational
11 stuff; but when you have a child that has a particularly
12 trying diagnosis because the behaviors are very
13 disruptive, let's say, or the thing is they're very hard
14 to get a kid on a reward or -- system because he just
15 doesn't seem to be negotiating with it, then the teacher
16 at the meeting typically is the one that says, you know,
17 "I need help" -- is that "For me to keep Johnny in my
18 classroom, it seems I need somebody not just to work for
19 Johnny. I need somebody to work for me about how it is
20 I can work with Johnny."
21 But I've seen in cases that I've gotten that
22 I've had to repair and I'm not saying that I didn't have
23 the support of my superior in repairing it; but I've
24 seen the evidence of what teams had put in place which
25 was huge amounts of hours that there's no way an
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1 educator could offer that amount of time for that kind
2 of support.
3 And when I asked of -- the therapist about
4 it, it turned out that what she was doing was she was
5 visiting TAs to check up on what they were doing. And
6 so, I called the clinical director after I talked to my
7 supervisor about it; and those hours were discontinued.
8 Q. How about medication monitoring, sir? I
9 think you explained that, but what does that mean to
10 you?
11 A. Well, it -- I want to explain it and it --
12 and, you know, embellish a little bit on it, I guess, is
13 that there's two levels to almost every problem that
14 we've challenged -- that we have -- let me say challenge
15 that we have -- is that there's economic and there's
16 clinical, you know, reasons for everything.
17 The downside of not -- even though the
18 department identified that this is the direction we need
19 to go into, it's just that we haven't gotten there, but
20 we need to arrive, is that the family physician, the
21 pediatrician, the one that takes care of the child for
22 the most part, under the parents' insurance or under
23 Quest, even if we have to pay the co-payment, would
24 empower the parent to be able to have control over
25 medicines given to their child.
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1 And I've had the -- our current clinical
2 director, Dr. Hirsch, who is a psychiatrist, and our
3 former director, Dr. McCarthy, who is a psychiatrist and
4 pediatrician, tell me the thing is is that it is
5 overkill to see a psychiatrist and neurologist every
6 month for medication monitoring.
7 Monitoring doesn't mean that they're
8 measuring the effectiveness of the drug as it -- you
9 know, it's, you know, affecting a behavior. Instead
10 they're just looking for physiological stress, for the
11 most part. What they're looking to see is: Is the drug
12 having a bad effect on the child? Is he twitching? Is
13 he -- you know, is it hurting his nervous system?
14 But, you know, your family doctor can do that
15 is -- so, what I've heard is that these -- what I've
16 been told by the practitioners in the field that are my
17 consultants is that we should move quickly in that
18 direction because involving the family physician, as I
19 said, empowers the family and also improves the quality
20 of the medical care the child receives because, like, if
21 the child is asthmatic and he's receiving an amphetamine
22 to control that, he certainly should not. And if the
23 child is getting Risperdal or he's getting, you know,
24 some other drug for the control of ADHD or something
25 like that, any HMO system -- what I go to is I go to my
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1 family doctor; and then from there, the thing is the
2 specialists are arranged. We need to get to that.
3 Q. What you're saying is that the system
4 requires these children to be monitored by another type
5 of specialist?
6 A. I'm not saying it requires it, but I'm
7 saying -- I'm telling you that's what's happening.
8 Q. And these types of specialists are in what
9 areas of specialty?
10 A. The specialists that the medical monitors go
11 to are either child psychiatrists or neurologists.
12 Q. And when you -- when you say monitoring,
13 though, from what I hear you testifying to, what you're
14 saying is that they go into this physician, whether it
15 be a child psychiatrist or neurologist. The physician
16 observes them physically.
17 A. Yeah.
18 Q. That's the clinical examination that's being
19 done, right?
20 A. Well, I don't want to speak for what all is
21 done by them; but it seems -- from my understanding,
22 yes, it's an observation and it's an observation to see
23 if the medicines are hurting the child.
24 Q. And you've talked to parents about this, have
25 you not?
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1 A. Yes, I've talked to parents about it.
2 Q. And asked them how long these typical visits
3 take?
4 A. Yes.
5 Q. What have they told you?
6 A. They don't take an hour.
7 Q. Well, do you recall what they told you about
8 how long these visits take?
9 A. Well, it depends. I've had parents that have
10 not been satisfied with the psychiatrist who was doing
11 the monitoring who was also doing the therapy for their
12 child; and I've had more than one complaint that they
13 thought that, yes, that the monitoring was very, you
14 know, superficial.
15 Q. Takes about five minutes maybe?
16 A. Maybe, maybe five, ten minutes. I've heard
17 those reports.
18 Q. How much do they charge for that service, to
19 your knowledge?
20 A. I'm not certain -- I'm not certain. The
21 thing is is that I -- it's in -- it's more than therapy,
22 I believe. The thing is that I would -- I would guess
23 it's around $100, something like that.
24 Q. Now, you say this -- the services could be
25 covered by insurance or Quest or something like that?
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1 A. Could be, sure.
2 Q. Do you know if the Department of Health
3 obtains reimbursement from health insurance providers
4 for paying for this service?
5 A. No, not that -- not that I know of. I --
6 we're supposed to be moving in that direction is that
7 there is -- you know, I have -- many of my children who
8 are autistic receive SSI; and when you receive SSI, the
9 things is you've got Medicaid for insurance. And the
10 thing is we need to be using that Medicaid because on
11 Medicaid eligible service, we get 50 percent back from
12 the Federal Government. And that kind of reimburses --
13 particularly in this economy. It's something -- we need
14 this vitally.
15 Also, the thing is it also kind of gripes me
16 that these parents pay the premiums for their insurance
17 and their insurance, because of the legislature, has to
18 provide 24 visits a year for the -- under it. And the
19 thing is they just write that off to I don't know what.
20 Growth? Is -- because the thing is they're supposed to
21 be using that premium to see these kids. That's all
22 you're being paid for. So, I don't know why we're being
23 so gallant in, you know, never really asking it to be
24 done.
25 Q. And the other areas, sir, you mentioned was
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1 intensive home care services. What were you referring
2 to there?
3 A. Well, the problem with it is that it
4 becomes -- it's opened-ended service; and it's not
5 supposed to be. My experience has been it's an
6 open-ended service. It's not supposed to last more than
7 12 weeks.
8 The thing about intensive in-home service is
9 what happens is is that Johnny is just such a problem
10 even at home, that even though these parents -- let's
11 say they're trying -- they're good parents -- because I
12 want to put it that way. I don't want to say that this
13 service is something that has to be done because the
14 parents had inadequacies. It's because the child has
15 these tremendous, you know, demands.
16 They're supposed to go in for up to 12 weeks,
17 and that's really it. No more than 12 weeks ever is
18 what, you know, our own standards imply. They're
19 supposed to go in and set up some behavioral systems so
20 that when they leave, the parents are in control of the
21 children. And the thing is they're enjoying their
22 children, hopefully, again; and because of the lack of
23 strife at home, the kid's going to do well in school and
24 go and get an education and be a good citizen and get a
25 job, I mean, the whole -- the whole package right there,
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1 right?
2 What happens is is that 13101 -- it doesn't
3 end; and when it doesn't end, that's what I had
4 mentioned. It has the opposite effect because the thing
5 is now Dr. Smith, Dr. Green, whoever it is, becomes the
6 expert in this family's negotiations on everything.
7 And so, of course, he's indispensable at this
8 point. He becomes a surrogate parent, and he ends up
9 going to the meetings. And all I hear from him is the
10 13101 therapist; and when I look to the parents, they
11 smile and nod on cue, you know, because what's happened
12 is they've had their natural authority taken away. And
13 it -- it costs a lot of money. It's always these
14 clinical money things.
15 Q. At the same time somebody is taking care of
16 their children?
17 A. Well -- pardon me?
18 Q. At the same time somebody is taking care of
19 their children?
20 A. Well, sometimes there will be -- a TA is
21 involved; but that shouldn't be taking care of their
22 children. That should be providing some certain need
23 under the guides.
24 What I'm saying by intensive in-home is that,
25 by design, it's supposed to be intensive. It's supposed
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1 to be short. It's supposed to be in your home and then
2 out. To let someone stay in your home for very long,
3 you end up abrogating your role in your child's life.
4 And it comes to decision-making about
5 services later because now you always have a
6 professional advocating for services instead of having
7 the parent tell you what they think they need to be able
8 to get a happy family.
9 Q. And the clinical standards for this type of
10 service is what, sir?
11 A. Clinical -- pardon?
12 Q. Standard. For how long should it be?
13 A. I believe it lasts for -- the last time I
14 read in clinical standards on 13101 is it couldn't
15 extend farther than 12 weeks without the division's
16 clinical director approving it.
17 Q. Have you seen situations where services were
18 continued beyond this 12-week period?
19 A. For years.
20 Q. In more than a few cases?
21 A. At least a few.
22 Q. Now, sir, you met recently with the auditor's
23 staff, the state auditor's staff, in August to discuss
24 your concerns, were you not?
25 A. Yes, I was called.
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1 Q. And you told your branch chief and your
2 supervisor that you were meeting with the auditor's
3 office?
4 A. Yes, I -- when I was called by Mr. Balder, he
5 told me that I could either do that or not or I could
6 meet him whenever I wanted, whatever I was comfortable
7 with; and I told him what I was most comfortable with
8 was making an appointment with him and going down to his
9 office and talking to my superiors that I was.
10 Q. And you took vacation time to do that,
11 though, didn't you, sir?
12 A. Well, I -- I wanted to make sure what I was
13 doing was appropriate. So, yes, I did.
14 Q. Sure.
15 A. As I have today.
16 Q. Sure. And you told your branch chief, and
17 that branch chief is whom?
18 A. David Drew.
19 Q. And you told -- you told your supervisor. I
20 think you've identified him, but that is whom?
21 A. Ken Gardiner, Dr. Gardiner.
22 Q. Dr. Ken Gardiner; is that right?
23 A. Right.
24 Q. Now, I understand that your branch chief,
25 Mr. Drews, attempted to call you during this meeting at
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1 the auditor's office; is that correct?
2 A. That's true. I didn't know it at the time.
3 I thought it was my wife.
4 Q. Did you have a cell phone or pager?
5 A. Yes, I had my cell phone with me.
6 Q. All right. And then you did talk to
7 Mr. Drews after this meeting?
8 A. Yes, because I called up, you know, a missed
9 call; and the thing is -- and then pushed the other
10 buttons -- because it was a number unfamiliar to me at
11 work, which surprised me because I had never given work
12 my cell phone number.
13 Q. How did he get that number then?
14 A. It turns out that he asked a colleague of
15 mine for it who had it personally and gave it to him.
16 Q. I'm sorry. He called whom?
17 A. He asked a colleague of mine for it --
18 Q. Okay.
19 A. -- who had it for personal reasons and he
20 gave it to him.
21 Q. And then what did Mr. Drews tell you when
22 you -- well, did you call him after the meeting?
23 A. Yes, of course.
24 Q. What did he tell you?
25 A. He told me that I would -- I needed to get a
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1 hold of the deputy AG's office because there was an
2 opinion that I -- it may not be appropriate for me to
3 testify and to the extent that the AG should go with me.
4 Q. Okay. What did you tell him?
5 A. I told him it was a done deal is -- the thing
6 is I was out of the meeting already, but the thing is
7 that certainly made me feel uncomfortable because I had
8 been assured that Dr. Anderson had said to fully
9 cooperate with the investigation. So, I was kind of
10 lost.
11 Q. You're not suggesting Dr. Anderson told
12 anybody not to cooperate with this investigation, are
13 you?
14 A. No, I'm not -- I'm not implying that at all.
15 I'm just saying -- I'm saying that's what I read in the
16 paper; and that's what I was told when Mr. Balder called
17 me. And so, the thing is the idea that there would be
18 any opinion to the contrary certainly surprised me.
19 Q. Sure. And you did speak with the deputy AG,
20 did you not?
21 A. Well, first, I called and couldn't get the
22 AG; and the thing is I was concerned. And so, the thing
23 is -- so, I called back to Erv Balder right away. And I
24 went, "Hey, you know, I just got through testifying with
25 you; and now I'm being told that I probably should have
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1 had my AG with you and I can't reach him but I just want
2 to let you know what the status of things are."
3 So, I tried the AG again. I did get the AG,
4 and he talked with me.
5 Q. What did he tell you?
6 A. He didn't tell me that. The thing is what he
7 told me was that he was my attorney; and if I was
8 uncomfortable coming before this Committee for any
9 reason, the thing is he would come with me but that
10 certainly I was supposed to cooperate with the
11 investigation.
12 So, I asked him the bottom-line questions.
13 What do I do if Mr. Balder calls me back?
14 And he says, "Well, certainly if you feel
15 comfortable, go ahead and cooperate with him."
16 I said, "Okay. Thank you." And I called
17 Mr. Balder back then because I didn't want him to
18 have -- social workers do that. I didn't want him to
19 have the misinterpretation that the AG had said what it
20 was that I had been told the AG said and -- you know,
21 because everybody's got the weekend. It was Friday.
22 So, the thing is I called him back and said,
23 "No, that's not" -- "that's not the situation." So,
24 that was the end of that.
25 Q. All right. In fact, the A -- he told you
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1 cooperate with the AG's -- with the auditor's office,
2 didn't he?
3 A. That was the tone, yes, is cooperate with the
4 investigation.
5 Q. And he told you if you felt in any way
6 uncomfortable, he would be with you whenever
7 you appeared?
8 A. I had the impression that he was acting, as
9 they always do to a social worker, as my attorney.
10 Q. And you did not feel that it was necessary to
11 have that representation; although, you do know you have
12 the right to have counsel with you?
13 A. I read that in the Subpoena; and, no,
14 presently I don't.
15 Q. Thank you. Now, you were instructed, though,
16 to debrief someone after this meeting with the auditor's
17 office?
18 A. No, sir. That was, I believe, that
19 Dr. Gardiner was asked to debrief me.
20 Q. Oh, I see. And who did you understand
21 instructed Dr. Gardiner to debrief you?
22 A. He told me David Drews.
23 Q. Do you have any reason to believe he was not
24 telling you the truth?
25 A. No, I have no reason to believe he was not
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1 telling the truth.
2 Q. Now, I understand, sir, as you sit here today
3 and as you are testifying honestly and fully, that
4 Mr. Drews is here in the room with you today -- with us
5 today?
6 A. Yes, that's true.
7 Q. And there are others of high positions from
8 the Department of Health in this room today?
9 A. Yes, that's true.
10 Q. They've spoken with you already, have they
11 not?
12 A. No, they have not spoken to me.
13 Q. Not today?
14 A. Not today.
15 Q. Do you feel uncomfortable that they're
16 there -- here listening to you?
17 A. Not really.
18 Q. Now, do you believe that there are others at
19 the Department of Health who are afraid to speak out
20 because of -- at the risk of losing their jobs?
21 A. Sure, I'm certain there are some that would
22 be -- that would be their fear. There's also the --
23 there's a pervasive problem that exists with what we're
24 doing is by having this Federal Court oversight is that
25 you can't admit that you got any problems, and that puts
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1 you in a rough spot because there's nothing mankind has
2 ever tried to do that there's not problems with.
3 So, you know, they would feel that they were
4 being, I think, disloyal somehow to the department by
5 not putting on the best face for those that are watching
6 us rather than just letting them see, as Abraham Lincoln
7 would say, "warts and all," you know, what our picture
8 was like.
9 Q. In other words, the truth is really not
10 coming out?
11 A. I think we're certainly emphasizing our
12 accomplishments.
13 Q. A few more questions, sir. Do you believe
14 that money that was intended to help Felix children has
15 been wasted?
16 A. Yes, I believe some of it has. I believe too
17 much of it has.
18 Q. Do you think that there is a lack of
19 appropriate control over spending?
20 A. Yes.
21 SPECIAL COUNSEL KAWASHIMA: No further
22 questions. Thank you.
23 CO-CHAIR REPRESENTATIVE SAIKI: Thank you
24 very much. We'll begin with the Members' questioning,
25 with, first, Vice-Chair Oshiro followed by Vice-Chair
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1 Kokubun.
2 VICE-CHAIR REPRESENTATIVE OSHIRO: Thank you,
3 Co-Chair Saiki.
4 EXAMINATION
5 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
6 Q. I just have a few clarification questions.
7 Particularly, when you were talking about the
8 therapeutic aides, I think you folks had talked about
9 the fee arrangement; and as I seem to recall, you said
10 there was a differential between how much the state pays
11 to the agency versus how much the agency would, in turn,
12 pay to the actual therapeutic aide; is that correct?
13 A. Correct.
14 Q. Do you know if there's any reason or
15 justification for what that differential and fee is
16 supposed to be provided for?
17 A. I believe it's training, supervision, and,
18 you know, the incurred responsibilities that an employer
19 is supposed to have in this state, even though almost
20 all of the TAs, Representative Oshiro, that I know don't
21 get medical benefits. They end up being independent
22 contractors.
23 Q. Okay.
24 A. That's -- yeah, that's exactly what I mean.
25 Q. Okay. So, the three reasons you've stated,
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1 one being the sort of benefits that are provided to
2 employees, they're mostly independent contractors. So,
3 that doesn't really apply?
4 A. Most TAs I know, yeah, don't get them.
5 Q. Okay. And then it -- when it comes to the
6 actual supervision, you've said that in your experience
7 you haven't seen too much of that supervision?
8 A. I believe that's a -- that's a belief also
9 held by my colleagues. I think that's generally held is
10 that we don't get any bang for the buck out of the
11 agencies themselves, is that we -- at the same time, we
12 want to be defensive of those people who are making
13 Herculean efforts to try to help the kids, you know,
14 some of the TAs themselves. But I -- like I said, in
15 the four years I've been out there, I've never seen any
16 active supervision of the TA by the agency.
17 Q. Okay. And then the third reason you said was
18 training; and in your experience, you found that they
19 actually didn't have the proper training and in
20 actuality you sometimes had to provide the training?
21 A. Many times.
22 Q. Okay. So, based on all of that, I understand
23 that you actually made -- you raised the concerns with
24 your supervisor. Who was that?
25 A. I've had various supervisors. This has been
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1 going on for four years that I've been -- the four
2 yours -- I was hired just after the model changed from
3 when the state provided these as direct services and we
4 started this privatization contract thing. So, it's
5 been -- it's been since the inception is the thing --
6 the TA services have been weak in that area.
7 Q. Okay. And throughout all those times that
8 you have raised those concerns, in your mind, you
9 haven't seen any resolution or any kind of cure of the
10 problem?
11 A. No, the only -- I don't think it's ever
12 been -- it's not even address -- that's -- it hasn't
13 been addressed, to my knowledge. These -- you know,
14 it's a contract issue.
15 Abuses have been followed up on by
16 supervision and administration. Like, if they find out,
17 when it has come to attention, somebody has serviced a
18 child 18 hours in one day or something like that, which
19 isn't humanly possible, the thing is, of course, you
20 know, it has been looked into; but as far as overall
21 about the services that we're supposed to receive from
22 the agency in support of each of these hours that we're
23 paying for, I haven't seen anything.
24 Q. Okay. And then also getting to the issue of
25 the in-school consultations, you had stated that in your
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1 review you thought that there were huge amounts of hours
2 that were just, obviously, too excessive; is that
3 correct?
4 A. Yes.
5 Q. What would be an example of an amount of
6 hours that was --
7 A. You know, one of the -- like I say, you know,
8 you have a economic and clinical side to everything and
9 certainly cases, you know, are different but they're not
10 that different -- is you can use some common sense.
11 If the teacher asked for an exert to help
12 them, it might be a few hours the first month. I was
13 asked, "Is it okay that they would bill for more than
14 once in one day?" And the answer is "yes" because a lot
15 of our children -- most of our children we have in
16 special ed classes and in regular ed classes. And so,
17 the consultant might have to come by in the morning and
18 see one and come by in the afternoon to see the other.
19 So, you know, I mean, there are some things that might
20 look abusive that weren't.
21 But on an ongoing basis, I mean, you use
22 common sense. How often would a teacher be able to
23 utilize a professional to talk about a student in her
24 classroom? And you come up with a number -- what, maybe
25 once a week, an hour a week, a couple of hours a month,
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1 something like that.
2 And I'll have cases that have come on my
3 caseload that the thing is the person is getting 30
4 hours a month and that means supposedly under our
5 standards they're spending 30 hours with that instructor
6 about that child and I've talked to the instructors.
7 That's what I do is I call up the school and
8 I talk to the SSC there and I talk to the teacher and
9 say, "Are you even the recipient of any of this?" And
10 they will tell me, no, they weren't.
11 And so, I -- as I explained earlier, I
12 followed through on it and said, "What was it being used
13 for?" And then we're back to the other problem. It's
14 being used in this therapist's mind to support the TAs
15 who were undertrained that were serving her child.
16 Q. Okay. But then had you not actually followed
17 up and done the actual review, is there any other person
18 in the hierarchy at your agency who would have also had
19 that review or would have caught that?
20 A. Well, as I said, I didn't receive it. I
21 received support in being able to reduce hours in the
22 case that I've cited -- is the thing is what I'm doing
23 is using it as an anecdote about how large that service
24 can be in place when it defies common sense that it
25 could be used in that way.
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1 Q. Okay.
2 A. It would have to be misuse somehow even if --
3 even if -- you know, I mean, it's fraud on the one hand
4 if it's being billed and there wasn't any service or
5 aide provided to the child's case because of it; but on
6 the other hand, I think what more often happens is the
7 thing is it's being used for things other than what it
8 was intended for.
9 Q. Okay. Then moving on to the issue of the
10 medication monitoring, as I understand it, you said that
11 at times it's a bit over much because the actual
12 clinical visits tend to be with child psychiatrists and
13 neurologists who tend to look more for physiological
14 side effects or reactions rather than an actual
15 therapeutic measurement; is that correct?
16 A. That's exactly what I was saying.
17 Q. Okay. What is the obstacle to prevent us
18 from moving in this direction? Why haven't we started
19 looking at that?
20 A. Focus and prioritization is -- and also just
21 a full understanding, you know, of -- of school based
22 but also family based services is that it -- I -- once
23 again, I'll, you know, be redundant -- is that it --
24 once again, if you empower parents -- it's good for them
25 to have their own doctor because the thing is they feel
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1 like they're more in charge of what's going on when
2 they're at their own doctor versus the idea that they've
3 got someone whose qualifications are so specific to just
4 feel that they could never be challenged. You could
5 never say, "Well, I'm sorry, Doctor. I don't think the
6 Ritalin is working that well." I mean, you'll do that
7 with your family physician; but how are you going to do
8 it with, you know, a child psychiatrist?
9 Q. And as to the last issue you mentioned
10 regarding the intensive home care services --
11 A. Yeah.
12 Q. -- you stated that -- I think, that by design
13 or by the -- your own standards, it's not really
14 supposed to go beyond 12 weeks because it's designed as
15 an intensive type of treatment?
16 A. Sure. I think -- I don't think we have to be
17 mental health professionals to understand that if you've
18 got someone inside the home making the decisions about
19 the behavior of the children and how the family relates
20 to each other, you can't go on for very long before it's
21 not going to have a positive effect.
22 Q. But in terms of the actual 12-week
23 quantification --
24 A. I'm pretty sure that's the clinical
25 standards.
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1 Q. Okay. So, when you say clinical standard,
2 that means that that's what you would find in the
3 actual -- just regular scientific accepted --
4 A. No, no. I'm not talking about best practice.
5 I'm talking about a book I got called Clinical Standards
6 that's made by CAMHD, by child and adolescent and mental
7 health. I'm saying we're out of whack with our own
8 policy.
9 VICE-CHAIR REPRESENTATIVE OSHIRO: Okay.
10 Thank you very much.
11 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
12 Vice-Chair Kokubun followed by Representative Ito.
13 VICE-CHAIR SENATOR KOKUBUN: Thank you, Chair
14 Saiki.
15 EXAMINATION
16 BY VICE-CHAIR SENATOR KOKUBUN:
17 Q. I've just got a couple of questions,
18 actually. I wanted to talk to you about your opinion
19 on -- or ask you your opinion about the transition of
20 school-based services and what -- how do you think
21 that's going to work out in terms of the DOE assuming
22 some of these responsibilities?
23 A. It has -- it has its positive points,
24 certainly. It does. It's got, I think, some of the
25 same problems we've had that aren't going to be in --
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1 much better except the fact that they're a new plan and
2 we all have hope for a new plan. It's just that I've
3 gone through so many plans. So, I'm going to be a
4 guarded optimist about the fact that a new plan is
5 always going to be a better one.
6 We had a problem with neutrality, I think, of
7 our assessments all along -- for example, is that when
8 we had agencies that provided other kinds of services
9 doing the assessments and making recommendations, they
10 were sure service chock full of recommendations; and
11 when they could refer to themselves or they could refer
12 to their agencies or they were building a pool, you
13 know, of children out there to be served, which, of
14 course, is good for the industry, I thought that their
15 neutrality was suspect.
16 I think the parents are going to feel the
17 same way about DOE, if they think they can have their
18 own employees do it.
19 And you're asking me how I feel it's going to
20 work. The thing is, I guess I'm already seeing a
21 pitfall I would hope we would sidestep; and that is hire
22 somebody neutral to do the assessments. The assessments
23 are so critical for the measurement -- for everybody
24 else, then, to put their team together to help, I think
25 you should just hire somebody like HMSA or somebody like
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1 that that's never going to provide another service, can
2 never be affected in any other way with what their
3 outcome is, and have them do it.
4 Because being a DOE employee, I think it's
5 just fraught with weakness -- I mean, a DOH employee do
6 it. As far as having therapists on campus so that you
7 don't always have to have a meeting to have somebody
8 come down and make an intervention about a child that's
9 having a problem, that's really good.
10 Q. So, in your experience, now, do you think
11 your work -- I mean, the Department of Health -- my
12 understanding is the Department of Health will still
13 maintain some level of care, particularly for the
14 high-end --
15 A. All we're going to have is the -- from my
16 understanding last, all we're going to have is the high
17 end; and we don't have the autistic children after July,
18 which compromised a large part of the high end -- in my
19 caseload, almost all of my caseload is autism.
20 Q. Okay. So, you -- your caseload, you're
21 talking about 15 or 20, I think it was?
22 A. Yeah, I have the preschools. I pick up the
23 children from zero to three from the early
24 intervention --
25 Q. Okay.
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1 A. -- and try to make that ground -- that
2 critical time between three and six years of age
3 because, you know, that's like Arnold Schwarzenegger
4 said in Kindergarten Cop, "That's where the action is."
5 You know, if you've got -- you've got to move from three
6 to six; and that's what I try to do for a living, you
7 know.
8 Q. Do you think the transition to school-based
9 services will have an impact in terms of efficiency of
10 spending?
11 A. It would be really speculative on my part
12 because I don't really know what they do. I know
13 they've hired a lot of school-based personnel, and in
14 some ways -- and, as I've said, I think the immediacy of
15 the reaction -- the familiarity that they're going to
16 have is to have a fair -- is to have a kid in this
17 school, this school, this school, this school is going
18 to be an advantage -- is they're going to know their
19 neighborhood and the teachers and the administrators in
20 the school. Those will all be good things to have
21 school-based therapy on.
22 So, I think that part will probably work. I
23 think the identification is still a problem; but then,
24 yes, if we're brought in if it goes high-end, it's going
25 to take one-on-one support outside of school. Inside is
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1 going to be DOE and one of the reasons they're taking
2 autism.
3 Q. How about specifically to your concern about
4 TAs, therapeutic assistants?
5 A. I don't know how the DOE is going to do it.
6 I've never been told how the DOE is going to take them.
7 All I've got to date -- I've got the date of
8 the 4th of July -- the thing is that my caseload and
9 those children are going to be the responsibility of the
10 Department of Education, but I haven't been told how
11 they're going to do it.
12 Q. I see. How are the -- how are the providers
13 responding to the transition to school-based services?
14 A. Well, they don't like it, for the most part.
15 It means that they're being replaced in what they're
16 doing by people in the school base, and anyone that has
17 confidence in their own career probably feels that they
18 do a lot better job than somebody else would.
19 But what they're afraid of is that they think
20 that -- you know, they think that their not being
21 employees of the state gives them a goal of pursuing
22 their ethical standards more than they feel state
23 employees will.
24 So, I've had providers tell me, yes, they're
25 suspect that if you're being reviewed for your promotion
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1 by someone inside the Department of Education, then the
2 thing is you're pretty much going to carry water for the
3 Department of Education. So, that's what the therapy --
4 that's what the providers are telling me. They think
5 that these people will not be neutral providers of
6 health care.
7 Q. We've already heard today about some examples
8 of the providers also not being exactly neutral and
9 aboveboard?
10 A. Yes, this is true -- is that -- I was really
11 more reflecting your question of what it is they're --
12 what it is they're saying to me.
13 VICE-CHAIR SENATOR KOKUBUN: Thank you.
14 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
15 Vice-Chair Kokubun. Representative Ito followed by
16 Senator Buen.
17 REPRESENTATIVE ITO: Oh, thank you,
18 Mr. Chair.
19 EXAMINATION
20 BY REPRESENTATIVE ITO:
21 Q. Mr. Stewart, you know, this morning we had
22 people coming up and talking about MST therapy. Do you
23 folks utilize MST?
24 A. Yes, we did. I didn't.
25 Q. What do you -- what is your opinion on --
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1 A. You mean, the Continuum or the home based?
2 Q. Both of them.
3 A. Well, the Continuum is no more. It was a --
4 from what I understand, the thing is the Continuum was
5 an attempt to follow through on the department
6 initiative to improve the best practice standards of
7 what we do in the state.
8 And so, what it was was it was an experiment.
9 We had a control group. You had to -- it was very
10 awkward for care coordinators. Of course, any
11 experiment is because, you know, you can -- you know,
12 who wants to be in the control group? I mean, nobody
13 wants to be in a control group. I mean, you know, if
14 you go down -- you have a problem. Who wants to be in
15 the placebo group?
16 So, yeah, it was disappointing because then
17 you had to recover it and go back the other direction
18 and say, "Well, we'll take good care of you anyway even
19 though that thing I got you all excited about you're not
20 going to be able to have." So, you know, I heard some
21 reports from care coordinators that they thought that
22 was kind of awkward, particularly now that it's come
23 back to us.
24 So, that -- I don't think it had -- you know,
25 I never did see an inherent -- an inherently good thing
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1 or progressive thing for the kids in it other than what
2 its outcome was supposed to provide and the data that
3 they could analyze and then see what was working and
4 what wasn't working.
5 When it comes to home-based, like I said, I
6 pretty much concentrate with the little kids, even
7 though I do go to group supervision and peer review with
8 the other coordinators that have the older children that
9 would be appropriate for the home-based MST program.
10 It's something that's got to be done. I
11 mean, otherwise, you know, what happens is that
12 children -- you know, they even say they only have,
13 like, a 60 percent projected success rate because it's
14 so hard at that point to reach children. It's an
15 ecological paradigm, the thing is, to try to control
16 everything the kid does.
17 That means you're going to have to have a lot
18 of initial cooperation to begin with, which means it
19 works really well with the middle-class family that's
20 highly educated that has a problemsome child because
21 they can understand everything we're talking about.
22 They're going to be able to cooperate and have a desire
23 to on all levels. They won't have conflicts with their
24 own.
25 But, you know, it's unfair -- in society we
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1 compare the costs of therapy to the costs of
2 incarceration; and what that leaves out is the cost of
3 victimization -- is all the people that got hurt along
4 the way by somebody before we finally locked them up.
5 And so, that's why to prevent that kind of behavior, I
6 mean, I'm all for it -- is that -- and I -- like I said,
7 taken as a caveat, the thing is that even they predict a
8 marginal success rate with it.
9 REPRESENTATIVE ITO: Okay. Well, thank you
10 very much.
11 THE WITNESS: Sure.
12 REPRESENTATIVE ITO: Thank you, Mr. Chair.
13 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
14 Representative Ito. Senator Buen followed by
15 Representative Kawakami.
16 SENATOR BUEN: Thank you, Co-Chair Saiki.
17 EXAMINATION
18 BY SENATOR BUEN:
19 Q. Mr. Stewart, I have a couple of questions.
20 Did you say that you attend the IEP meetings?
21 A. Yes, I do.
22 Q. You do? Okay. If there are disagreements
23 between the members of the IEP team in the kind of
24 services that should be provided for the child, what
25 happens then? Are there -- are there disagreements on
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1 how long --
2 A. Yes.
3 Q. -- is this period?
4 A. Yes, there are -- commonly there are
5 disagreements about what level of services is that --
6 it's a very difficult spot for the care coordinator.
7 Excuse me. We're supposed to come up with a consensus
8 of some kind.
9 Q. So, when it's your role, how do you --
10 A. Well, that's what you do. You try to use
11 your mediation skills to be able to get people to -- as
12 I'm sure legislatures do -- is to agree on what we can
13 agree on, so that we can put that in the plan and start
14 moving forward and then isolate what it is that we can't
15 agree on and hopefully, because we're in the stream of
16 progress of agreeing on all of the other things, the
17 thing is there will be enough give and take that
18 everyone's opinion can be considered and a plan can be
19 constructed.
20 But, see, that's the problem with when you're
21 making, you know, soup like that is that the services
22 need to be targeted clinically towards what best
23 practices tell us will be successful for the child.
24 You're not supposed to put together a service plan that
25 makes everybody in the room happy. That's not the
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1 point.
2 The point is not to make the advocate happy,
3 the lawyer happy, the teacher happy, everybody else.
4 The point is putting together a plan that will work.
5 And there has to come a point where you have to call
6 their bluff on the whole thing is -- for four years,
7 I've said when it comes -- when push comes to shove when
8 there's a violation of what I know is clinically in the
9 best interest of the child -- is I'll say, "Well, then I
10 guess we have to go to mediation or hearing"; and I've
11 never gone in four years.
12 Q. Do you have any -- any of these teams that
13 have gone on for a long, long time and for -- what is
14 the longest period that you've --
15 A. Senator, you're identifying a very crucial
16 point is that I don't let them become trials of
17 ordeal -- is that -- and, generally, I have
18 administrators from the school support on that now as
19 we've all learned the Felix system is -- I had a
20 principal at Ala Wai Elementary -- God rest her soul.
21 She just passed on. But she had a rule that the thing
22 is an IEP was one hour with ten minutes for the
23 conference notes. And she ran it like a train. And for
24 the most part, you could get just as much progress done
25 in that one hour if everybody knew they only had one
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1 hour than the idea that people could constantly revisit
2 issues until they finally wore you down.
3 I won't do it. And, yet, yes, I have heard
4 of cases and know of cases in my offices where they've
5 had six-, eight-hour marathons in there trying to reach
6 consensus.
7 Q. Okay.
8 A. You have to be -- it's not effective. You
9 have to reconvene.
10 Q. Okay. My other questions are to the area of
11 the TAs.
12 A. Uh-huh.
13 Q. Did I hear you say that we can get -- you
14 know, the agencies that are out there, do you feel that
15 the TAs can do a good job or -- without the agencies?
16 A. I think they are -- is because as I've
17 explained is even though the --
18 Q. Do you --
19 A. Go --
20 Q. Did you say that we can cut out the middle
21 person, that that would be the agencies?
22 A. I believe so, Senator, because I'm already,
23 as I've explained, paying for the training of these
24 people so that they can be qualified TAs in a system
25 that makes the agencies training costs superfluous.
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1 It's not existent.
2 Q. Do you feel that it would be cost effective
3 for the state -- or I don't know if that's the right
4 term to use -- to train the TAs and do away with the
5 agencies?
6 A. Boy, it's going to be rough for me to get a
7 TA here pretty soon, isn't it? But the answer is yes.
8 Q. So, do you feel that the division has the
9 people to -- enough people to train the TAs?
10 A. I must say I'm not saying they're being
11 trained by a division -- is even though division might
12 have that academic muscle, I don't know what they have
13 hidden in personnel, but --
14 Q. Do you have any ideas?
15 A. -- I do know that my aide -- my therapists
16 are doing it now; and, yes, I know that there are some
17 principal therapists in autism, for example -- usually,
18 TAs, they divide them into two groups, the ones for PDD
19 autism and the ones for behavioral problems. Those are
20 your two biggies, and that's how they're trained.
21 And on the autism one, yes, we could put
22 together a few of the autistic experts, even with a
23 couple of national caliber guys, and have trainings for
24 them and still come under, I believe, the price we're
25 paying the agencies.
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1 Q. Okay. And this would be for statewide?
2 We -- we're talking about statewide?
3 A. You would have to do it statewide.
4 Q. Including Molokai and Lanai?
5 A. Yes, yes, ma'am.
6 Q. Thank you. The other question that I have
7 is: Is there a way for your division -- or is there
8 a -- is there something in your division that is now
9 being used to measure the services and purposes and what
10 was paid? Is there some kind of a program that you have
11 to measure the services and what was paid?
12 A. Do you mean against a standard of the amount
13 dollar-wise against whether or not your case is in some
14 sort of excess? I don't know if I fully understand your
15 question because I don't do the fiscal tracking.
16 Q. Do the agencies -- do the TAs -- or is there
17 some kind of program that the division has of what were
18 the services provided and what was paid to the agencies,
19 to the TAs -- is there some kind of program that you
20 have?
21 A. I don't know of one. I don't -- I still
22 don't fully understand.
23 Q. How do you -- how does a division measure
24 what was paid out?
25 A. Well, the division has the -- we send out
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1 service authorizations to the agencies; and the thing is
2 through the MIS system, our computer system, when
3 they're authorized -- and the thing is that data becomes
4 available to, of course, CAMHD and all the directors.
5 So, they would know what was going out. They know how
6 much is paid. They know how much is paid every month.
7 Reports like that are manufactured. Quarterly reports
8 are sent to the parents telling them the dollar figure
9 and all the services that are provided. So, that data
10 is available.
11 Q. That's available?
12 A. Uh-huh.
13 Q. Okay. So, we can get a printout of that?
14 A. Yes, you can.
15 SENATOR BUEN: Okay. I have no further
16 questions. Thank you.
17 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
18 Senator Buen. Representative Kawakami followed by
19 Senator Sakamoto.
20 REPRESENTATIVE KAWAKAMI: Thank you very
21 much, Co-Chair.
22 EXAMINATION
23 BY REPRESENTATIVE KAWAKAMI:
24 Q. Mr. Stewart, I wanted to follow up with a
25 question I had asked Dr. Gardiner; and that was: On the
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1 IEPS, okay, let's say at a certain time there's some
2 children that you see that might be able to exit the
3 program.
4 A. Right.
5 Q. Is that possible?
6 A. You mean, do children age out or finally
7 matriculate out of services? Because they do. I -- we
8 have cases that, yes, go from high to low end.
9 As a matter of fact, the -- just this week I
10 had an autistic case go from high to low end that most
11 people would think, just by definition and diagnosis,
12 could never happen; but it turns out that the child has
13 mild autism and the school, Lunalilo, thinks they can do
14 without any TAs.
15 So, the thing is they told me you're going to
16 get rid of the TA about a month or so ago; and we had to
17 reassign him someplace else. And then they -- the thing
18 is that they didn't need our intensive in-home anymore
19 because the parent felt she's learned everything that
20 she needed to know about it. So, now, the child's --
21 they're trying to reach this child through their
22 specialists at DOE at Lunalilo. So, yeah, it can
23 happen, yeah.
24 Q. Okay. Well, that's what I wanted to know.
25 So, there is that kind of thing happening?
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1 A. Yes, there is.
2 Q. And --
3 A. More in the -- of course, in that
4 diagnosis -- that diagnosis is a bit more stubborn PDD
5 autism is the -- a fewer of those will be able to reach
6 independence than the other high-end children we have,
7 say, for the ones, like I said, that are adolescent
8 because they're really -- they're also very intractable.
9 So, it's very hard to turn them around, too.
10 So, it's kind of like you're behaviorally
11 disruptive kids that I -- you know, the four-year-old
12 that will choke the little girl in school with her --
13 and the thing is, of course, her parents aren't real
14 thrilled about him choking their little girl.
15 And so, he ends up having to go to a day
16 treatment program for a few months, one of the ones that
17 we run; and they do work on his self-control and on --
18 you know -- and when they're little like that, you know,
19 it's real possible; and the child comes back. And the
20 thing is it's no longer considered behavioral disruptive
21 and is no longer considered a high-end child. And we
22 have some problems in the future, but he just needs to
23 go to a counselor like anybody else.
24 Q. Well, do you have another IEP?
25 A. Yeah.
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1 Q. Okay. And that -- and he said it's done once
2 a year, yearly.
3 A. No, it's whatever is called for. It has to
4 be done annually. That's federal law. Any time you get
5 together to change anything substantive, the thing is
6 you need the school on board. The DOE is the dog.
7 We're the tail, you know, that they ride. We're the
8 related service -- is the thing is if the school isn't
9 the one that's calling for our help, then, you know,
10 there's no bells going off.
11 So, we don't call IEPs typically. Typically
12 what we do is we inform the school that mental health
13 feels that a meeting needs to be called; and they'll
14 call it or the parents will.
15 Q. Okay.
16 A. And if the therapist wants it done, they know
17 they're smart enough, you know, to tell the parents to
18 call.
19 Q. Okay. Well, what I was trying to get at is
20 if, you know, you have children that you can see that
21 they -- they have accomplished --
22 A. Yeah.
23 Q. -- moving on and so forth that they -- you
24 don't wait for the IEP to come up.
25 A. No.
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1 Q. You call it --
2 A. No.
3 Q. There's things that --
4 A. The therapist gives me a month -- remember --
5 well, maybe you don't know. The therapist gives me a
6 monthly report. And at the bottom of every one of
7 them -- the department is very insistent about this on
8 any services. You're supposed to have a discharge date;
9 and, you know, the thing is that they also work in
10 percentiles which sometimes is kind of ludicrous because
11 they'll tell you the child is getting 10 percent better
12 every month and we've had him for two years --
13 Q. Right.
14 A. -- which means he's 240 percent better now.
15 Yeah, I know. So, that -- you know, that doesn't work
16 out all that well; but usually out there -- the thing is
17 the therapist is the one that's going to tell me that
18 they want to discontinue services.
19 Q. Now, I've heard this phrase a couple of
20 times. Children are overmedicated in the schools.
21 What's your opinion --
22 A. No, I don't believe --
23 Q. -- as a social worker?
24 A. As a social worker, the thing is I don't -- I
25 believe that's a generalization. That's really not
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1 founded. I think that our medication monitoring and the
2 medications that we have -- I've said the thing is I
3 think we have a great deal of oversight onto that issue.
4 So, if you're talking -- but, see, when it
5 comes to medication, you know, your question is -- query
6 is kind of interesting. On the one hand, you might have
7 medications that are being given to kids that's going to
8 have a negative physiological effect on them. No,
9 because the thing is we've got so many neurologists and
10 psychiatrists, I don't see how in the world that could
11 possibly happen.
12 Q. Uh-huh.
13 A. On the other hand, the thing is when the
14 child's behavior becomes controllable, is there an
15 aggressive plan to reduce the medication so that we can
16 see if the child can continue to maintain an acceptable
17 level of behavior without the support? I don't think
18 we're doing enough of that.
19 Q. Uh-huh.
20 A. Yeah. So, I've got some quiet kids that I
21 think, you know, maybe shouldn't be so quiet -- is the
22 thing is maybe there is a bit too much control because
23 that means they fit into the DOE classroom, and everyone
24 on the team supports it.
25 Because when the social worker speaks up and
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1 says, you know, well, now, we're going to have to see
2 what we can do to reduce that kind of medication, most
3 people say, "Why in the world do you want to fix
4 something that's not broken?"
5 Q. Uh-huh.
6 A. But the reason is the effectiveness of the
7 medication tires after time anyway. So, if you want
8 that magic bolt, you can't use it all the time because
9 otherwise later when puberty or something else happens
10 and this kid who has a different nervous system than you
11 or I do needs a little bit of help, you want to make
12 sure you haven't burned out the one have -- the one
13 thing you did have going for you.
14 Q. So, that check is done how often, as far as
15 you know?
16 A. Medication monitoring for duress, like I
17 said, it's done monthly. As far as whether or not the
18 child's behaviors have stabilized so that it can be
19 reduced, once again, I think that whose -- whose
20 interest that's going to be in, for the most part, will
21 be the family doctor. And that's why I want the family
22 doctor back in the loop because the family doctor is
23 going to be the one, like I said, that's going to be the
24 buffer or the filter between the parents and the
25 parents' concerns. The parents are concerned.
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1 I went to a DOE meeting one time, and the DOE
2 spoke up and they said they just didn't understand why
3 these parents got all these radical ideas about Ritalin
4 and stuff. And I said, "Well, your community college
5 out at Kaiser where I live has two classes on" -- "that
6 adults can take on the dangers of Ritalin. So, where do
7 you think they get this information" -- is the thing is
8 that these are common concerns.
9 Q. Uh-huh.
10 A. And that's why they need to talk about it
11 with someone that they trust that's going to remain in
12 their child's life; and that's the family doctor.
13 Q. Thank you. On the therapeutic aides, you
14 were talking about -- let's see. Does it have to be, on
15 psychotherapy, one-on-one all the time --
16 A. It does not have to be one-on-one all the
17 time.
18 Q. -- with the students with the children --
19 A. No, on the --
20 Q. -- working with them one-on-one?
21 A. No, that's the exact term, Representative,
22 that has to be used in the IEP is one-on-one support.
23 Now, one-on-one support, when promised in an
24 IEP, can take different forms and, see -- and that's
25 what I try to work towards is you can either have an
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1 EA -- an educational assistant can be assigned to the
2 classroom to help the teacher out because she's got some
3 special ed kids that we're trying to mainstream. That's
4 not one-on-one. That's called an EA.
5 But they do have a PPT, a paraprofessional
6 trainer, I think it is; and that's a one-on-one support
7 for a child that really just needs constant prompts to
8 be able to have an education. It's only if they're
9 having a behavior that exceeds just having an attention
10 span problem that -- and that is only true of PDD
11 autistic kids, that the department will allow the TA to
12 be put into the classrooms.
13 Typically those children early on need a TA
14 all the time. When they get older and have gone through
15 the critical time of junior high school transition --
16 because you have to move around in classes and you have
17 different teachers and all that stuff. When they get to
18 that point where they get a little bit more settled down
19 in high school, then, things like art or library or
20 those kinds of things, they can program without
21 one-on-one support.
22 Q. Okay. I understand that. Let's see if I
23 have anything else.
24 REPRESENTATIVE KAWAKAMI: I guess that's all
25 for now. Thank you very much --
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1 THE WITNESS: Thank you.
2 REPRESENTATIVE KAWAKAMI: -- Mr. Stewart.
3 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
4 Representative Kawakami.
5 We would like to take a very short break so
6 that our court reporter's hands don't fall off.
7 THE WITNESS: I appreciate -- I can hear her
8 going away the whole time.
9 CO-CHAIR REPRESENTATIVE SAIKI: We'll have
10 recess for five minutes.
11 THE WITNESS: Thank you.
12 (Recess from 3:48 p.m. to 3:57 p.m.)
13 CO-CHAIR REPRESENTATIVE SAIKI: At this time
14 questioning by Senator Sakamoto followed by
15 Representative Leong.
16 EXAMINATION
17 BY SENATOR SAKAMOTO:
18 Q. I heard you say three to six -- is that your
19 primary responsibility area?
20 A. For the most part, most of my cases are.
21 Probably 75 percent are defined by saying that they're
22 less than eight years old.
23 Q. Okay. In that area, you talked about the
24 soup. So, there's a best practice menu cookbook on what
25 ingredients you put in to get the right formula, so to
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1 speak, not to dehumanize the people but in a mix of
2 providers, mix of --
3 A. Just like medical practice, there's certain
4 things they try first because it usually works.
5 Q. As of this point, you have a cookbook menu
6 that -- well, for the age group that you're working
7 with?
8 A. Not really.
9 Q. Okay. Is it being developed?
10 A. There's -- there -- yes, there's a best
11 practices model that's being developed that the -- like
12 I said, a part of the research effort on the
13 department's part was to look at the literature that had
14 control groups; and from that, they've come up with
15 kinds of therapy, not necessarily amounts but kinds of
16 therapy.
17 Q. Okay. So, it's more tried as opposed to
18 evidence based in the current practice?
19 A. Yeah, I think that's true of the field.
20 Q. But it's moving more towards evidence based?
21 A. It's moving more towards evidence-based
22 services.
23 Q. Okay. In the IEP process, you know, you
24 talked about people changing and, you know, thank God
25 people progress from, you know, high end to low end.
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1 A. Right.
2 Q. In the IEP, are there "if then" sort of
3 statements that if Johnny progresses from here to here,
4 then we'll progress with doing this, if he goes down, if
5 goes up? Are there enough "if then" statements so that
6 you don't have to reconvene an IEP as opposed to letting
7 current course of events run for 18 weeks until
8 everybody gets together and changes course?
9 A. That's a -- a very primary question, Senator,
10 is -- I wish that we could -- I try to be as successful
11 as I can be in doing that, in trying to build objectives
12 that have time dates that when those time dates happen,
13 then changes in the services are recorded in the
14 conference notes of the IEP, so that it can progress to
15 the next stage without having to be reconvened.
16 Q. Uh-huh.
17 A. It's hard to predict the full match of
18 services in the future. So, I end up having to go to
19 IEP meetings to redesign them far more often than I want
20 to, you know, far more often than a lot of times I think
21 should be necessary because that's because I -- you
22 know, I'm getting better and better at constructing the
23 language that you're talking about so that we don't have
24 to meet as frequently.
25 Q. My hope is the process -- what I hear
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1 sometimes is the process gets in the way of the changes
2 that are needed?
3 A. That's true because when you -- if you are
4 just following the plan -- okay. All -- most plans are
5 not going to be 100 percent successful, okay. So, if
6 you're following a plan that is evidentiary pretty
7 successful to 80 percent and you just want to move on
8 into phase two, you don't want to reconvene and have
9 everybody revisit their position about what service they
10 advocated for at the last meeting and trying to pin the
11 tail on the donkey by saying, you know, if you had done
12 what I told you, the thing is the child would be a lot
13 better now. So, it has to be -- it's a puzzle of many
14 pieces.
15 Q. What needs to change? Is it our rules on IEP
16 or what needs to change to allow professionals and
17 people who are knowledgeable to be able to help the
18 child soon?
19 A. Well, the thing is -- is that what
20 constitutes an IEP, I think, could -- you know, which is
21 properly federal law, could probably be cut down. I
22 don't know if we have any control over that because you
23 have to have an administrator, the special education
24 teacher, and a regular education teacher at every IEP
25 meeting that you have.
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1 In cases that are active, there's probably
2 not a lot of consideration on the -- on the academic
3 level to tie down these teachers constantly out of their
4 classrooms to be able to meet. So, we ought to be able
5 to have the mental health treatment team, which is the
6 therapists and the guardians, be able to make more
7 decisions away, I think, from having to have the full
8 body of the DOE there at every step of the way.
9 Q. So, maybe --
10 A. It's kind of second-guessing in a way at that
11 point when, the thing is, you start asking educators
12 what do they think the next component of a mental health
13 treatment plan should be rather than just focusing on
14 what they should be telling us, which is what's wrong
15 with Johnny and how well is Johnny doing now?
16 Q. So, maybe it's an initial IEP and maybe a
17 Stage 2 IEP which is three of the eight people or
18 some --
19 A. I think you could -- yeah, I think at one
20 point -- the thing is when it came to high-end services,
21 I remember years ago we pretty much had it that way on a
22 practical level -- is that if we were going to tinker
23 with anything inside the school day, then, of course, we
24 had to meet with DOE. It's their store; but if we were
25 talking about increasing respite hours because the
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1 mother had the flu, you know, and couldn't take care of
2 her ADHD autistic child or whatever, then, the thing is
3 we didn't think we needed to take teachers out of the
4 classroom to be able to make a decision like that.
5 Q. Okay. And changing the subject --
6 A. Sure.
7 Q. -- I guess earlier, Dr. Gardiner, I believe
8 was -- talked about Loveland being the only day
9 treatment center. I did visit Kalani School and that's
10 not in your complex area but isn't that a day treatment
11 that -- option to Loveland?
12 A. I'm not real familiar with Kalani.
13 Q. Okay.
14 A. I know that in our complex and our district,
15 I believe the only day treatment program for autism is,
16 I think -- yeah, I think Loveland's got the ball.
17 Q. Okay.
18 A. The -- CARE has a seed program that on the
19 biopsychosocial, for example. I believe CFS does, too.
20 There's some managed competition there; but for the day
21 treatment, I'm pretty sure that's true. But I don't
22 have any children in.
23 Q. At least in your area, that may be the only
24 one?
25 A. In my area -- my experience with Loveland is
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1 very small -- is that I've placed one child there in a
2 biopsycho -- God, it's a long word -- social program.
3 He was a gifted child, had an IQ of, like, 145 but was
4 illiterate; and it turned out we had to get diagnosis
5 about dyslexia and stuff.
6 But during that time, we wanted to do
7 something about his self-esteem because he was becoming
8 violent. I mean, of course, if you have a violent kid
9 you can't reach, it would be really frustrating. Once
10 again, you don't have the mental health expert here.
11 So, we tried to get him some challenging
12 curriculum in that program for a few months after
13 school. Then after we got a handle on the learning
14 disability things, I took the kid out of Loveland. So,
15 I only used it once.
16 Q. A kind of final area of questions: Who kind
17 of does the indicators, in other words, like learning
18 progress, you know, one to six, one being poor and six
19 being good -- who starts to periodically say, you know,
20 Johnny was two. Now, he's --
21 A. Right.
22 Q. -- three --
23 A. Well, two different measurements are made.
24 Two kinds of measurements are made simultaneously. DOE
25 is always working on the IDEA on what they call the
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1 PLEP. It used to be the PLOP. The PLOP was Present
2 Levels of Performance, but somehow that wasn't good
3 enough. So, we went with PLEP, which is Present Levels
4 of Academic Perform -- Educational Performance.
5 Actually, I know my E's from my -- it's Educational
6 Performance.
7 That measurement is -- there is -- they
8 actually draw a picture of the child's progress in multi
9 dimensions. So, they try to graph it out so that you
10 can see the trajectory of the case as to whether or not
11 it's going up or whether or not it's going bad or
12 whether or not you've got pretty much a flat line.
13 I also do quarterly measurements on the
14 children. I do what's known as a KALOCS -- or CALOCS, I
15 guess, because it's California Level of Care Systems,
16 something like that, and the CAFAS, which is Child and
17 Adolescent Functional Assessment System, I think. Both
18 of those measure -- even though a lot of times they're
19 limited to reports I receive, but they measure how the
20 child is doing at home, how they're doing in school, how
21 they're doing in the community, if they're starting to
22 use drugs and stuff like that so we can have some check.
23 And after every three years -- you know,
24 after a year or so involvement, which would not be
25 unusual for a high-end child, the thing is you should
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1 have some points in time. So, the thing is you can
2 start being more evidence based; but the schools
3 pretty -- should be pretty -- you know, I mean, that's
4 their day-to-day thing. You couldn't teach without
5 measuring. That's why we often have those tests all the
6 time.
7 Q. Okay. So, now, you're doing your CALOCS and
8 CAFAS and we're doing the PLOP or PLEP --
9 A. Yeah, that's it.
10 Q. -- or whatever else. As the system has
11 started to transition -- and, obviously, not everybody
12 transitions over -- how are you working together with
13 the school in the way you've been tracking outcomes to
14 help them receive people based on your CAFAS and CALOCS,
15 et cetera, et cetera?
16 A. Well, those -- what those measurements do is
17 in an aggregate sense when you -- you know, when you
18 look at the -- you know, all the kids that we serve, it
19 becomes a meaningful measurement against what kinds of
20 services you've -- that we've been providing the kids.
21 Q. DOH type?
22 A. Yeah, DOH and DOE -- DOH means -- what I'm
23 talking about is what direction we need to go on that.
24 And so, it's -- but on the individual case, okay, is you
25 can't be dependent on the tools of measurement of
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1 things. You have to have good lines of communication
2 between all members of the team. You have to be talking
3 on a regular basis with the therapist, not just be
4 dependent on the monthly report. You've got to be going
5 by and making school observations with the child and
6 talking with the teachers to see how they're doing. You
7 have to be calling the parent on the phone -- usually
8 they don't want you to come by their house, which I
9 don't -- you know, I don't blame them; but, you know,
10 you can meet them at Starbucks. You can meet them
11 somewhere, you know, so, the thing is, they can talk to
12 you about the progress of the child. That's how you're
13 going to make decisions on a case-by-case basis. These
14 measurements are just to show the big picture about
15 where we're going and where we need to go.
16 Q. So, those are not as individual. They've
17 more --
18 A. No, you're talking to people every day as how
19 it is that -- you know, guys work together. You hold
20 each other's hands -- is the thing is you're supposed to
21 be a team on -- we're all supposed to be -- you know, we
22 got so many adults together. We're all supposed to be
23 so smart. The kid doesn't have a chance, you know.
24 He's going to have to get better.
25 Q. Well, what measurable outcomes can people who
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1 aren't in the small discussion look at to say "good
2 job"?
3 A. I guess that would be those kinds of
4 indices -- is the thing is they would be looking at what
5 we do on our case loads instead of trying to find that
6 particular point in the case that's made the difference.
7 It's awful hard to tell sometimes.
8 Q. Okay. Well --
9 A. Yeah.
10 SENATOR SAKAMOTO: Okay. Thank you, Chair.
11 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
12 Senator Sakamoto. Representative Leong followed by
13 Representative Marumoto.
14 REPRESENTATIVE LEONG: Thank you, Chair
15 Saiki.
16 EXAMINATION
17 BY REPRESENTATIVE LEONG:
18 Q. Mr. Gardiner -- Mr. Stewart, rather -- excuse
19 me. It's getting a little bit late there.
20 A. Yeah.
21 Q. Mr. Stewart, I -- when you were queried about
22 excessive spending and you indicated about the
23 medication monitoring --
24 A. Yes.
25 Q. -- and you felt that maybe that we should
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1 have the family doctor be sought -- being sought more
2 than the specialist --
3 A. That's correct.
4 Q. -- who makes that determination? And it's
5 once a month and you said it was like an overkill.
6 A. I think so, not -- I think so,
7 Representative, based on the fact that, as I told you,
8 my present and my formal clinical director, who are
9 psychiatrists, supposedly are going to give me the
10 straight story rather than, you know, dissolute me -- is
11 that they -- that the family doctor is the one that
12 should be brought more into this loop.
13 And I don't believe the department disagrees
14 with this position because, obviously, they're being
15 informed of it by their employees, like, their clinical
16 directors. It's just that I think that we need to move
17 with more haste in that direction because it is a waste
18 of resources to have a specialist see someone for a
19 condition that doesn't require a specialist. It also
20 inhibits good family practice for the family doctor not
21 to be the one that's being informed about what's going
22 on. Because, like I said, I think they represent the
23 parents better because they're the family's doctor, not
24 just the child.
25 Q. So, you see this as a practice that is
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1 forthcoming very soon?
2 A. No, I don't see steps to make it -- coming
3 very soon.
4 Q. Oh, okay. Well, my next question has to do
5 with intensive home care; and we talked about a 12-week
6 period. Could you elaborate a little bit on this home
7 care period?
8 A. Well, the -- it's supposed to be in -- the
9 reason that they use the word "intensive" is the thing
10 is it's supposed to be, you know, a lot -- is it means
11 that really pretty much these people show up when Johnny
12 gets out of school and the thing is they stay with the
13 parents all the way until they go to bed because they
14 say, you know, he won't go to bed. He stays up and
15 watches TV.
16 They say, "Well, why don't you tell him to?"
17 "Oh, because then he'll have a tantrum and
18 he'll break something, you know; and then my husband
19 yells at me. And so, I just don't do it. I just let
20 him stay up."
21 And you go, well -- then he falls asleep in
22 second period at school; and the thing is the teacher
23 goes, "Well, you know, I can't teach an unconscious
24 student." So, sometimes it's just as basic parenting as
25 that.
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1 REPRESENTATIVE LEONG: Thank you. That's the
2 end of my questions. Thank you, Chair.
3 CO-CHAIR REPRESENTATIVE SAIKI: Thank you
4 Representative Leong. Representative Marumoto?
5 EXAMINATION
6 BY REPRESENTATIVE MARUMOTO:
7 Q. Another question regarding the excessive
8 spending. On school consultation --
9 A. Yes.
10 Q. -- you said something about the TA not
11 spending that much time in school. You're not seeing
12 them spending --
13 A. No.
14 Q. -- that much --
15 A. My point was that I did not see the
16 supervisors of the TAs from their agencies ever make a
17 campus visit to see their people do their job.
18 Q. And that is a cost driver? Is that --
19 A. That's part of what we pay the agencies for
20 and, yet -- so, there's -- it's a double whammy. On the
21 one hand, I've been told by Special Counsel it can be as
22 high as $30 an hour; and with -- the person that's
23 receiving it is only getting 15, which means for every
24 hour that student has a one-on-one, that agency gets 15
25 bucks.
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1 Q. Uh-huh.
2 A. And what do we get for that? Supposedly
3 supervision and training and clinical oversight, and we
4 don't get any of that.
5 Q. Uh-huh.
6 A. So, of course, that's a waste; but then the
7 double whammy is then I end up having to pay therapists
8 to do school consultation work to be able to take over
9 that responsibility and train the TA so they can meet
10 the needs of the child.
11 Q. Uh-huh.
12 A. So, I get ripped off the first time because I
13 paid for something I don't receive. Then I get ripped
14 off the second time because I have to pay for something
15 to take care of what it was I didn't receive because I
16 still needed it.
17 Q. Okay. Thank you. I think I have a better
18 understanding of that now.
19 REPRESENTATIVE MARUMOTO: Thank you.
20 THE WITNESS: Sure.
21 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
22 Representative Marumoto. Co-Chair Hanabusa?
23 EXAMINATION
24 BY CO-CHAIR SENATOR HANABUSA:
25 Q. Mr. Stewart, I just have a few questions. In
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1 the four years that you were part of the Diamond Head
2 branch of the Department of Health, were you ever aware
3 of an audit being performed on Loveland?
4 A. I was told that that was -- I was told
5 recently by Dr. Gardiner the thing is is that there was
6 an internal audit of Loveland. That was weeks ago.
7 Q. Before that, were you ever aware of one?
8 A. No.
9 Q. Were you ever aware of any complaints against
10 Loveland?
11 A. Yes.
12 Q. And that -- when did it start in your four
13 year --
14 A. I think from the beginning.
15 Q. From the beginning?
16 A. Yes.
17 Q. Was it from fellow colleagues?
18 A. Yes.
19 Q. You said you've only placed one.
20 A. I've only placed one, but the thing is I've
21 had -- I believe I've -- yeah, I've -- half a dozen of
22 my colleagues who have had placement responsibilities
23 have reported problems with the placement at the agency.
24 Typically it's issues like, you know, accountability.
25 Q. And who did they make these complaints to?
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1 A. Everybody.
2 Q. In your four years --
3 A. Excuse me, if I could embellish, Senator.
4 Our Q and -- we have a Q&A staff. We have a couple of
5 individuals that at least at one time were fielding
6 complaints. They had received so many is the thing is
7 that became one of -- I know one of their higher
8 priorities was just sifting through the complaints.
9 Q. Okay. During your four years, has Mr. Drews
10 been your branch head?
11 A. Yes, he has.
12 Q. Were you ever aware of whether Mr. Drews was
13 made aware of the complaints against Loveland?
14 A. Oh, I'm sure he was.
15 Q. Did Dr. Gardiner raise his concerns with you
16 prior to you hearing them today?
17 A. Yes, I've heard them in group supervision,
18 which is where Dr. Gardiner -- that's the appropriate
19 forum for it -- is the thing is he reviews what he
20 thinks are problems and our being able to overcome these
21 barriers so a kid can get an education; and I know that
22 he's had some problems with Loveland.
23 Q. What happens to your students after they turn
24 six? You said you kind of take them until six.
25 A. What happens is I have elementary school.
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1 So, they got a little older than six. What I meant --
2 three to six, that in the literature, that's the time to
3 really target autistic PDD kids. That's the time where
4 you put in lots and lots of services because the thing
5 is that they're wrapped quite a bit of the day because
6 that's the time where we can offset that kind of
7 disability, that processing problem.
8 Literature supports that. The thing is don't
9 be afraid of spending money and resources on them from
10 three years old to six years of age. And then what
11 happens, of course, you get less of a -- you get a
12 marginal return. And you get less of a bang for your
13 buck. And if you haven't identified them in that early
14 period, you may never be able to successfully offset it
15 to the degree that we expect it to be offset it.
16 When people ask me about autism, they'll say,
17 well, you know, Mr. Stewart knows a lot about it. I
18 know a lot about what we know about autism. What we
19 know about autism is not a great deal, but we do know
20 that. So, that's why I've clustered in the elementary
21 schools. That's what happens. When they graduate from
22 elementary school and they go to junior high school, I
23 lose the case.
24 Q. You lose the case?
25 A. Yeah.
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1 Q. Now, during this three to six period --
2 you've only placed one in Loveland and --
3 A. He wasn't even an -- an autistic child
4 either.
5 Q. He was an exceptional child?
6 A. He was an exceptional child who could not
7 read or write.
8 Q. Now, what Dr. Gardiner seemed to say is that
9 Loveland is the only game in town for high-end needs
10 like autism. So, what -- where are you placing your
11 children if you're placing them anywhere?
12 A. That's a good question is that I don't -- I
13 don't place them in day care programs. What I do is I
14 support the schools in being able to take care of them
15 in fully self-contained classrooms. I do utilize
16 biopsychosocial program. The one I utilize is the seed
17 program out of CARE. And I think that the therapists
18 and the families are generally pleased with it; but,
19 once again, I can't put a kid in there unless I put a TA
20 in and the TA is supposed -- that's service is already
21 being compensated, I believe, by the agency because they
22 told me -- it's transitionary is -- when you place the
23 kid here, could you give us the TA for the transition;
24 and the transition just never is.
25 Q. So, you use CARE?
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1 A. Yeah. But I don't use day treat -- I don't
2 use day care at all.
3 Q. Right.
4 A. I'm using this as an after-school program to
5 try put another pack in there to try to get these kids
6 moving when they're that young.
7 Q. Any other provider?
8 A. Not for biopsychosocial services. CMS is way
9 out on Weaver Road or something like that. So, I don't
10 use them.
11 Q. One last question, you said therapists and
12 campuses, of course, where the DOE model is moving to --
13 I didn't get a sense from you whether you felt that was
14 good or bad. Do you have an opinion?
15 A. I think for them to be on campus is good, and
16 I thought I had said -- or I'll certainly repeat what I
17 think is good about it is I think it's good that the
18 therapist works with the teachers and the administrators
19 so that it's their school, you know, so you have that
20 kind of pride and cooperation about the fact that you're
21 Kaiser or whatever you are rather than the fact that
22 you've got these people coming in, these -- you know,
23 these experts from someplace else which are sometimes
24 resented, you know, when you -- you know, this is your
25 school. It's your classroom, and some -- a lot of times
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1 I'll have teachers that don't like the 14101 that they
2 get, let alone -- the thing is not be asking for a bunch
3 more because they feel like they're being talked down
4 to. And so, I think the intimacy and familiarity of
5 having the people on campuses is a good thing.
6 Also, reaction time -- Senator Sakamoto's
7 point about do I have to call an IEP when Johnny, you
8 know, loses it in the classroom to be able to suggest
9 some more or other kind of intervention. And if you had
10 somebody there at the school, no, you wouldn't.
11 The only -- the one thing I did say about it,
12 though, on the downside was that since they -- if they
13 intend on having assessments done by DOE personnel, the
14 charge will be made -- the thing is since they don't get
15 paid anymore for taking any more kids, that they're only
16 going to have as many problems as they have hours in the
17 week.
18 Q. One follow-up question, you've basically said
19 that your high-end autistic children, which is primarily
20 what you deal with --
21 A. Yes.
22 Q. -- you have them in the contained classroom?
23 A. Fully self-contained classrooms.
24 Q. So, what happens -- or do you know what has
25 happened to your children after they've left you? Like,
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1 have some of them gone into Loveland after that or have
2 they been able to be maintained in classrooms within the
3 DOE system?
4 A. I don't know of anybody that wasn't able to
5 be maintained in the DOE system.
6 CO-CHAIR SENATOR HANABUSA: Okay. Thank you
7 very much.
8 CO-CHAIR REPRESENTATIVE SAIKI: Thank you
9 very much, Co-Chair. I actually don't have any
10 questions. So, I would like to entertain any follow-up
11 questions at this point. If there are none, thank you
12 very much, Mr. Stewart.
13 THE WITNESS: Thank you.
14 CO-CHAIR SENATOR HANABUSA: Members, at this
15 time, we would like to put on the record the following
16 point. One is, as you are all aware, we had also listed
17 today Dr. Judith Schrag to appear; and as you have been
18 informed, she will be appearing and has volunteered to
19 appear on another date. Today was not a convenient time
20 for her. However, the condition of her appearance we
21 have left to Mr. Kawashima to negotiate; and we're
22 hoping that we'll have a resolution of that. And that
23 is why you have not seen any motion to quash our
24 Subpoena today.
25 In addition to that, while we were in
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1 executive session, we discussed further Subpoenas; and
2 at this time, the Co-Chairs would like to move that this
3 Committee authorize the issuance of Subpoenas of the
4 following individuals. And as per our prior Subpoenas,
5 it will be up to the discretion of the Co-Chairs as to
6 when they will be scheduled.
7 The individuals are as follows: Dennis
8 McLaughlin of CARE; Sharon Nobriga of Hawaii Families as
9 Allies; Vicky Followell of Hawaii Families as Allies;
10 Edwin Koyama, DOE internal audit office; Valerie Ako,
11 DOH administrative services office; Anthony Ching,
12 former deputy director of the Department of Health; Kari
13 Rachlin of CAMHD; Mary Brogan of the DOH CAMHD, clinical
14 director; Alan Shimabukuro of the Department of
15 Education.
16 Are there any discussion? If not --
17 CO-CHAIR REPRESENTATIVE SAIKI: I'll take a
18 roll call vote, Members. Co-Chair Hanabusa?
19 CO-CHAIR SENATOR HANABUSA: Aye.
20 CO-CHAIR REPRESENTATIVE SAIKI: Vice-Chair
21 Kokubun?
22 VICE-CHAIR SENATOR KOKUBUN: Aye.
23 CO-CHAIR REPRESENTATIVE SAIKI: Vice-Chair
24 Oshiro?
25 VICE-CHAIR REPRESENTATIVE OSHIRO: Aye.
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1 CO-CHAIR REPRESENTATIVE SAIKI: Senator Buen?
2 SENATOR BUEN: Aye.
3 CO-CHAIR REPRESENTATIVE SAIKI:
4 Representative Ito?
5 REPRESENTATIVE ITO: Aye.
6 CO-CHAIR REPRESENTATIVE SAIKI:
7 Representative Kawakami?
8 REPRESENTATIVE KAWAKAMI: Aye.
9 CO-CHAIR REPRESENTATIVE SAIKI:
10 Representative Leong?
11 REPRESENTATIVE LEONG: Aye.
12 CO-CHAIR REPRESENTATIVE SAIKI:
13 Representative Marumoto?
14 REPRESENTATIVE MARUMOTO: Aye.
15 CO-CHAIR REPRESENTATIVE SAIKI: Senator
16 Matsuura is excused. Senator Sakamoto?
17 SENATOR SAKAMOTO: Aye.
18 CO-CHAIR REPRESENTATIVE SAIKI: Senator Slom
19 is excused. Ten ayes, two excused.
20 CO-CHAIR SENATOR HANABUSA: Thank you very
21 much. Members, does anyone have any other points or any
22 other business? If not, we will be adjourning this
23 hearing. Thank you very much.
24 (The hearing was adjourned at 4:22 p.m.)
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1 C E R T I F I C A T E
2 STATE OF HAWAII )
3 ) SS:
4 CITY AND COUNTY OF HONOLULU )
5 I, SHARON ROSS, Notary Public, State of Hawaii,
6 do hereby certify:
7 That on Wednesday, October 3, 2001, at 9:08 a.m.,
8 the hearing was taken down by me in machine shorthand
9 and was thereafter reduced to typewriting under my
10 supervision; that the foregoing represents, to the best
11 of my ability, a true and correct transcript of the
12 proceedings had in the foregoing matter.
13 I further certify that I am not attorney for any
14 of the parties hereto, nor in any way concerned with the
15 cause.
16 DATED this 15th day of October, 2001, in
17 Honolulu, Hawaii.
18
19
20 SHARON ROSS, CSR NO. 432
Notary Public, State of Hawaii
21 My Commission Expires: 4-8-05
22
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