Less than 24 hours after state child welfare workers were warned of the risks of suddenly relocating a 16-year-old foster care child with severe medical and psychological problems to a new home, the girl was hospitalized, and her former caretakers fear for her health.
The girl, whom we'll call Vanessa, is one of 12 foster children who were relocated to Houston from group homes in west Texas operated by Children's Hope. The State Department of Family and Protective Services suspended Children's Hope's contract in January and launched an investigation into what department officials called "a number of serious contract violations...that directly impact the safety and well-being" of children. (A total of 80 children were removed.)
Since the children came to Houston in February and March, sources say, their requests for medical services have been denied or delayed by Centene, the St. Louis-based, Fortune 500 company that manages Medicaid coverage for thousands of children in Texas's care.
The delays in Vanessa's nursing services, coupled with her sudden move last week to an ill-equipped foster agency, call into question how seriously some DFPS supervisors are heeding a 2015 federal court decision ordering state officials to provide better oversight for the state's most vulnerable children.
In Vanessa's case, records show that, after the girl was moved to Houston in February or March, Centene routinely refused to allow a nurse to come and administer her insulin. The girl's medical regimen was further interrupted July 22, when case managers abruptly moved her to a group home operated by a company with multiple violations.
Sources say the new home wasn't even made aware that Vanessa was diabetic and had serious issues with aggression. Records show that the girl's new foster mother, apparently unable to deal with Vanessa, called police, who took the child to a psychiatric hospital only hours after she moved into the new home in Richmond. (A 2015 psychological evaluation of Vanessa stated that the girl's outbursts were often the result of feeling "overwhelmed" and when she "does not understand what is expected of her.")
Emails obtained by the Houston Press show that at least two people responsible for Vanessa's health care warned her caseworker in Harlingen, and other DFPS officials, that a sudden move could have serious consequences.
Vanessa's story is achingly similar to those of the 12,000 other foster children who were the plaintiffs in that class-action suit: neglected by her mother and intermittently housed with other family members, Vanessa later told a psychologist she had been abused and raped by family members. One of the men, she said, gave her two bucks, candy and juice every time he made her perform oral sex on him.
The girl also suffers from Prader-Willi syndrome, a condition that can cause a chronic feeling of hunger and lead to obesity and diabetes.
Unfortunately, DFPS ultimately decided to stash her at Children's Hope in Lubbock, which had a history of abuse and neglect long before state officials got around to investigating earlier this year. Many, if not all, of the 80 kids removed from Children's Hope were temporarily housed in San Antonio, with at least 12 winding up in Houston.
It does not appear that Vanessa was assigned a local caseworker — hers remained in Lubbock. Secondary caseworkers, called "I See You Workers," are supposed to check on kids who have been transferred out of their home cities, but it's unclear if Vanessa was ever paid a visit. (Vanessa also has an attorney ad litem, who would not confirm for the Press whether he was aware of her hospitalizations or relocations.)
After a rocky start, sources say, Vanessa seemed to bond with her house mom and staff at Love & Joy Personal Care Home, classified under the Home and Community-Based Services program run by the Texas Department of Aging and Disability Services.
Because of severe intellectual disabilities, Vanessa could not administer her daily insulin injections, and relied on nurses from a home health-care company called Avida.
On April 8, Avida asked Centene to approve 12 home visits over six weeks, but Centene only approved six visits over three weeks, stating in a letter that nursing visits "are not medically necessary. (The Press asked Centene about the denial, but we have not heard back.)
Unfortunately, in late April, after the authorized visits expired, records show, Vanessa's glucose level skyrocketed, and she was rushed to Texas Children's Hospital for emergency treatment.
Upon Vanessa's discharge, a physician wrote that the girl's "intellectual disability and behavioral challenges can result in non-compliance with diabetes diet recommendations as well as insulin administration." The doctor recommended twice weekly visits by a nurse.
Avida then sought approval for 60 visits, but Centene only authorized 46. Those expired in early July, and on July 8, Vanessa was once again hospitalized.
A physician noted in a follow-up visit that it was important to allow skilled nurses to administer Vanessa's insulin, because missed dosages "may be severe and even life-threatening."
Centene, it should be noted, doesn't just value health and welfare — it values thrift. The company's slogan, "Better health outcomes at lower costs," clearly states the company's twin imperatives. Its CEO, Michael Neidorff, is evidently so good at balancing service and cost that, in 2014, he was given a $3.6 million bonus, on top of a $1.2 million salary and $13 million in stock options, according to the St. Louis Post-Dispatch.
A week after the July hospitalization, Love&Joy was notified by DFPS case managers that Vanessa and two other kids were going to be moved, but no explanation was provided.
Love&Joy owner Sheila Swirczynski told the Press that she felt she let the kids down. When she got the children, she says, they were in rough shape. One smeared feces everywhere. Others punched holes in walls and tore up blinds. Once, after tearing up the place, one of the boys ran to his room and packed his suitcase, expecting to be kicked out, because that's what happened everywhere else.
Swirczynski said that she worked hard to gain their trust, and to let them know that she wasn't going to get rid of them.
"I told them, 'Don't you destroy this; this is your house,'" she told the Press. "So everything I sold them on, now, it becomes a lie. So now I know I can't tell kids that, because I don't want to actually be the person that's not being true to [them]."
Patrick Crimmins, the DFPS spokesman, denied allegations that Vanessa's new foster care agency was not aware of her medical condition, stating in an email that each child's caseworker "is responsible for the safety and well-being of that child; the worker also ensures that the child gets the appropriate medical/psychological/psychiatric assessments, so that care and treatment can be provided as necessary."
Moreover, Crimmins added, each child has a health "passport" that is "always accessible to CPS, any other medical consenters, and authorized medical providers. The passport is a computer-based program with relevant medical info about diagnoses, prescriptions, most recent hospital stays, recent doctor/dentist visits, immunization records, etc."
Crimmins also wrote that, in certain critical cases, CPS workers will conduct additional safety checks. He wrote that this was done with all former Children's Hope kids "to make sure they feel safe and that all of their needs are being met."
He also explained that DFPS officials, along with House and Senate legislative committees are studying the department's "chronic capacity problem," and will be presenting a report to the full Legislature in a few months.
Ideally, the story would end here, because one would hope that, in the wake of the federal ruling, state officials are upping their standards for where they place kids. So one might assume that there wouldn't be glaring red flags among the adults in the kids' orbit.
Alas, that is not the case for Vanessa.
The teen's new home in Richmond is operated by a company called Vericon, which is owned by a registered nurse named Jorfui "Dolly" Kandeh-Dabo.
Vericon's most recent state inspection — back in January — turned up violations for failure to conduct employee background checks and "comprehensive assessments" of clients. Vericon was also cited for failure "to provide or obtain as needed and without all delay" all services the clients are entitled to under Medicaid, and failing to timely enter "critical incident data" in the department's database. (Love&Joy's most recent inspection, in May, turned up a violation for failure to "ensure monitoring of individuals' health information" and to ensure that "unlicensed staff only performed nursing tasks identified in the individual's nursing assessment.")
Vericon's charter was revoked by the Secretary of State in January, for failure to pay franchise taxes. A spokeswoman for the Texas Department of Aging and Disability Services told the Press , "If [a]...contractor loses their corporate certification or charter, they are issued a notice that gives them 30 days to reinstate it. Failure to resolve the issue will result in the involuntary termination of the contracts."
By the time Vanessa was moved to Vericon, the company had been operating without a charter for more than 170 days.
A previous home run by Kandeh-Dabo was sold at a court-ordered auction in 2008, after Kandeh-Dabo's business partners sued her for embezzling funds from their company, JD Homecare.
Fort Bend County District Clerk records show that the former business partners, who were also nurses, accused Kandeh-Dabo of engaging in Medicare fraud with a friend who ran a state-contracted health-care company called Texas Human Healthcare Services.
The business partners alleged that Kandeh-Dabo cashed JD Homecare's Medicare checks and gave the cash to her friend, "who then wrote a check to Kandeh, personally," according to court records, which include copies of checks to Kandeh-Daboh totaling roughly $40,000.
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In a final flourish of sketchiness, federal court records show that Kandeh-Dabo was detained at Bush Intercontinental Airport on a flight to her native Sierra Leone in March 2010 after a routine customs inspection revealed she was carrying nearly $20,000 in cash. Federal law requires a person to file a report if he or she is transporting more than $10,000 in cash out of the country. According to the federal complaint, Kandeh-Dabo lied to the customs officer and said she was carrying only $5,000. The money was divided among seven envelopes bearing different people's names.
The money was seized, and Kandeh-Dabo subsequently filed a motion to recover the funds, stating that she was only delivering the money to family members of her associates in Houston. In an agreed final judgment, half of the money was returned.
Kandeh-Dabo did not respond to requests for comment, nor did she provide any paperwork showing that Vericon's charter had been reinstated.
It's unclear if Vanessa will return to Kandeh-Dabo's home when she's discharged from the hospital, or if she'll be moved again. And it's still unclear why she was moved in the first place. Maybe one of these days, her caseworker, hundreds of miles away in Harlingen, will tell her.