From: Summer Harrison <summerlynne2@gmail.

com>
Subject: Evercare letter re Hannah Harrison
Date: November 21, 2010 5:07:13 PM HST
To: David W Heywood <david_w_heywood@uhc.com>
Cc: "Laura (HHS/OCR) Coronado" <Laura.Coronado@hhs.gov>, Torris Smith
<Torris.Smith@cms.hhs.gov>, "Spector, R M. (CMS/WC)" <Richard.Spector@cms.hhs.gov>, "Ellen
W. (CMS/CMSO) Blackwell" <Ellen.Blackwell@cms.hhs.gov>, "Ruff, Cynthia L. (CMS/CMSO)"
<Cynthia.Ruff@cms.hhs.gov>, "Cheryl (CMS/WC) Young" <Cheryl.Young@cms.hhs.gov>, "Ruiz,
Susan F. (CMS/WC)" <Susan.Ruiz@cms.hhs.gov>, "Rubio, Steven C. (CMS/CMSO)"
<Steven.Rubio@cms.hhs.gov>
1 Attachment, 289 KB

Dear Dave:

I am writing this email in response to the certified letter you sent

me on November 5 (attached).

1. With regard to the October 7 letter from Dr. Koh, that letter was
handed directly to Evercare's attorney when she was sitting in my
living room on October 8. It was my understanding that she was present to
represent you. Otherwise, I would not have admitted her to my home. Your
attorney discussed the issues covered in the letter briefly, so there was no question your lawyer knew
the
letter was for Evercare. Carol Franklin was also at that meeting.
Hannah's lawyer was there as well, so I believe that the delivery of the
letter to your attorney, especially when in the presence of Carol Franklin,
was both appropriate and effective as to delivery to Evercare. Thus,
Evercare's response is substantially overdue at this time, and your response
does not provide a valid reason for the delay.

2. Per Evercare's procedures, Carol Franklin, Hannah's service

coordinator, was given the documentation for what your lawyer calls
the "5-5-5" services in May (five hours a week each of PT, OT and
functional communications therapy). Your lawyer discussed these
services with Hannah's attorney, Rafael Del Castillo, during the
October 8 meeting, and again at the October 18 meeting Evercare called
at my house.

I have been following your official procedures. Your attorney, your

Medical Director Cheryl Ellis, and your service coordinator all
acknowledged that formal requests for the "5-5-5" therapies had been
submitted in May and never yet responded to.

Cheryl Ellis presumably arranged to fly a speech pathologist over from

Oahu to evaluate Hannah on October 18 because she recognized there was
an outstanding issue of services requested in May.

3. I am copying various state and federal authorities on my emails

because I have been asked to. On two separate occasions (the most
recent October 20, 2010) CMS has emailed me that Med-QUEST has
informed them that Evercare is meeting all its required timelines and
there are no outstanding service denials for Hannah. CMS thus must be
receiving false information.

Evercare has never responded to the official requests for services

submitted in May 2010. Legal timelines have therefore been greatly
exceeded. When I spoke with Joylyn Hargrove on June 29 she acknowledged you were
already outside the fourteen day legal response time for the services
prescribed by Dr. Koh. An additional four months and two weeks have expired
with no action by Evercare.

4. I am not overly worried about the security aspects of email. It

is the best and most efficient means for me to communicate. You may respond
with a secure pdf or fax if you prefer.

You told me in July you wanted "to better coordinate services" with
DOE and DOH. I am not aware of any change in the existing coordination, to
the extent you can call it that. I emphasized the lack of any such
coordination to Carol Franklin and your lawyer on October 8 and again on
October 18. Any attempt at coordination has failed to address my daughter's
critical need to learn to communicate her medical needs to us. She has, on
several occasions now, suffered extreme distress because she cannot
communicate where she hurts. I worry every day that she will be unable to
communicate a condition which, if not caught early enough, could lead to
serious permanent harm or even death. Evercare cannot deny knowing that she must be able to
communicate about her physical conditions because I have raised it
repeatedly. I believe Evercare does not care.

The videotaped evaluation done on October 18 made it clear Hannah can

benefit from these functional communications therapy services, and
that the structure for providing her the services that she needs is
not available in Hawaii. Your lawyer and your Medical Director left
saying they would get back to us. We still haven't heard anything, and in
that 30 days, Hannah has had a critical need to communicate at least two
conditions we could not see and which required days and days of frustration
and pain for her before we figured out what was wrong.

Lisa Ing also said during that evaluation that the longer we wait to
get Hannah the type and level of services she needs, the harder it
will be for her to relearn something she thinks she already does
successfully. We're seeing the harm being created as Hannah is being
increasingly confused by all the wrong therapies she's getting. She
understands the concept of the Dynavox but is getting no training in
using it to communicate functionally with us, so is forced to try to
rely on vocalizing. The more we don't understand her, the more
distraught she is becoming, to the point of risking life-threatening
aspiration.
Her inability to communicate pain to us, a simple thing to teach on
the Dynavox, led to a potentially serious skin breakdown developing.
We knew something was wrong, and could have begun treating it two days
earlier if she had known how to tell us using the dynavox.

I do not feel it was appropriate for you to attempt to sweep this

issue under the rug with a letter telling me I'm not following your
procedures. I understand that DHS makes certain documentation requirements
but those should not stand in the way of Hannah's care. As for your request
that I stop emailing others, I cannot comply. When I adopted Hannah, it was
made very clear to me that my duty as a parent is to advocate for her as
vigorously as necessary to make sure that she is safe and she can achieve
her optimum development. If my efforts are in some ways embarrassing to
Evercare, that is a small price to pay for ensuring Hannah's safety and
growth. I not only expect Evercare to understand and respect my attempts to
fulfill those duties, but to strongly support me. Certainly, lobbying me to
forsake them is wholly inappropriate.

Sincerely,
Summer Harrison