CHARLOTTE, N.C. (WBTV) – Three calls to the WBTV Investigates tip line over the past two months have put a personal face on the questions surrounding Cardinal Innovations’ ability to provide care to the mentally ill and mentally disabled in Mecklenburg County.
Cardinal is under fire from county leaders, who have accused the agency—which is tasked with managing the care of children and adults covered by Medicaid and other state funding—of providing sub-standard, untimely or inadequate care.
On Tuesday, executives with Cardinal spent more than two hours addressing county commissioners and staff. Executives with the agency, which is funded entirely by state and federal tax dollars, said they are struggling to provide sufficient medical treatment for their clients amidst budget cuts.
But the stories told by three women who called WBTV for help paint a different picture.
Two women—one a mother and the other a grandmother who has permanent custody of her granddaughter—had a paper trail showing months of Cardinal staff denying requests by their children’s care providers for residential mental health treatment.
A third woman—whose daughter is profoundly mentally disabled, non-verbal and confined to a wheelchair—brought documents showing a years-long effort to get Cardinal to authorize the constant, one-on-one car her daughter needs.
All three women told stories of having their child’s care providers request authorization from Cardinal for one level of care only to have that request denied in favor of a lesser level of care.
In an interview with WBTV, a Cardinal executive defended the agency but couldn’t answer specific questions about decisions made by company employees that denied care recommended by doctors and therapists.
Marcia Farrow’s six month delay for help
Marcia Farrow was the first parent to contact WBTV about the saga of getting her daughter, Nicole, the treatment she needed authorized by Cardinal.
“It took me over six months to get her the care that she needed,” Farrow said. “She was continually denied and denied with no valid reasons. And she’s not the only one.”
Nicole Farrow was adopted when she was three, her mom said. She was exposed to drugs and alcohol in the womb.
Marcia Farrow describes her daughter as having “very serious mental health issues.”
According to medical records Farrow provided to WBTV, her daughter has been diagnosed with Disruptive mood dysregulation disorder, Reactive attachment disorder, ADHD, Separation anxiety disorder and Oppositional defiant disorder.
Her medical records show she’s received therapeutic foster care in four different settings, intensive in-home treatment and day treatment. None of the treatment has been successful, the records show.
That’s why, Farrow said, her daughter was admitted to an in-patient psychiatric medical treatment facility in September.
While she was admitted, doctors and therapists at the hospital requested authorization from Cardinal for Nicole to go into a psychiatric residential treatment facility.
“PRTF level placement will assist with different parenting strategies to enhance, build and develop new strengths and assist with providing a wider selection of tools for Nicole to utilize when in difficult situations,” a psychotherapist wrote in her request for authorization to Cardinal.
“Nicole’s personal experiences and considerable instability in the home environments suggest that therapy which focuses on but is not limited to psychoeducation and parenting skills, relaxation affect expression and regulation, and cognitive coping will be of benefit to her,” the request continued.
That request was made on September 24. Cardinal issued a decision on October 1 denying the request.
“Specifically, based on the information provided, Nicole’s needs could be addressed within a lower level of care,” the letter from Cardinal explaining why the request had been denied concluded.
Farrow immediately appealed Cardinal’s decision and the agency denied the request a second time roughly a week later, on October 10.
“There is no indication Nicole requires a 24 hour therapeutic environment or cannot be treated effectively in the community,” the second denial said.
Farrow submitted three additional letters and evaluations from three other care providers, all of which said Nicole needed residential treatment, between October and January.
One letter detailed the long history of being admitted to the hospital for inpatient psychiatric care and outlined why Nicole could not be treated outside of a residential setting.
“A higher level of care is warranted given Nicole’s continual history of elopement, causing her to nearly be hit by a car and getting into a car with a stranger in the past, inability to engage in therapy in the community to address her challenges with trauma and significant attachment deficits, frequent aggressive episodes towards caregivers, and threats to kill herself and others,” the evaluation said.
“Although Nicole is young, all other services have been exhausted at this time besides a group home setting and the treatment team is in agreeance that that setting would not be appropriate for Nicole’s needs nor equipped to handle her psychological symptoms,” the evaluation continued. “Nicole has significant psychiatric and trauma history, and she has not demonstrated the ability to engage in most treatment interventions with the therapist or psychiatrist individually or in a group setting with her peers.”
But Cardinal denied the request a third time on January 17.
“There is nothing to show that Nicole requires a 24-hour therapeutic environment,” the denial letter said. “There is no information to suggest she cannot be safely and effectively treated in the community. Nicole’s symptoms and treatment can be managed in a lower level of care.”
Nicole was finally admitted to a residential treatment facility in late February, nearly six months after the first request had been made.
“It’s been the hardest journey of my life, honestly,” Marcia Farrow said of the effort to get Cardinal to approve the care medical professionals said Nicole needed.
In an interview with WBTV, Cardinal Chief Operating Officer Dietrick Williams defended the work his agency does in providing care for its clients.
“Cardinal remains committed to ensuring that all of our members receive high quality service in a timely and appropriate manner,” Williams said. “We make sure that these decisions are done timely, they’re done as expeditiously as possible.”
Williams said the decisions Cardinal staff make are based on clinical factors but couldn’t explain why in the case of Nicole Farrow and the two others investigated by WBTV, the agency denied services being requested by clinicians.
“We work very diligently to make sure that decisions are made in a timely manner,” Williams said.
“Is six months timely?” a WBTV reporter asked, referring to Farrow’s case.
Williams, at first, responded with a blank stare and several seconds of silence before answering the question.
“You know, it seems like a long time,” he said. “I don’t disagree with you.”
Six months was too long for Marcia Farrow to wait while her daughter waited on the critical psychiatric help that she called “life or death.”
“I just don’t know what it takes for them to do the right thing the first time, all the time and not have to go through this,” Farrow said. “No parent should have to fight this hard.”
‘This is not right for the life of a child that is asking for help’
Brenda Ballard called WBTV after years of trying to get her granddaughter the mental health treatment she needs.
Ballard and her husband have permanent custody of their granddaughter, who is 13.
Records show her granddaughter has been admitted for inpatient psychiatric treatment at a local hospital facility eleven times between October 2018 and February 2020. She is still admitted to an inpatient psychiatric hospital now.
The records from her licensed clinical social worker note that at least one admission to the hospital involved the police being called. Another involved visible cuts on the girl’s arms.
According to her therapist, the girl continues to want to harm herself.
“While in the care of Behavioral Health Center [name redacted] has tried several times to self harm. [Redacted] has spoken with staff there and have disclosed several times the want to end her life,” the therapist wrote. “Drawing out plans and making lists of options she believes she has to harm herself.”
Cardinal denied the request to place the girl in a psychiatric residential treatment facility. Recommending, instead, to place her in therapeutic foster care.
The most recent decision to uphold the denial of care came on March 4.
“Although [redacted] has made suicidal threats, she has only been admitted to the hospital once in the last 8 months, and was released as stable enough to return home,” Cardinal’s March 4 denial said.
Brenda Ballard carries around a thick stack of documents, including medical records and letters from Cardinal, that document her journey to get her granddaughter the mental health treatment she said will save the child’s life.
“Let me make it clear, if we agreed to TFC, we would lose our grandchild. We would lose her,” Ballard said. “She has stated a plan. She has stated it to the in-home therapist, written out in detail even at school and tried to figure out a plan at school. So they’re playing chess with a child that is screaming for help.”
In his interview with WBTV, Williams said a decision about Ballard’s daughter had not been made.
“This particular case is still in the review process and, so, no final decision has been made, as I understand it,” Williams said.
“We work with family members to review all clinical documentation to make the best clinical decision,” he said.
A WBTV reporter held up the March 4 denial letter from Cardinal stating the company would not pay for Ballard’s granddaughter to receive residential treatment. The reporter also held up the letter from the girl’s therapist listing the nearly one dozen psychiatric hospital admissions.
“What you’re saying just doesn’t seem to stand up to the documents that we have in our hand,” the reporter said to Williams.
“I haven’t seen those documents but I’m sure those documents are being reviewed by our medical directors and our clinical team,” Williams responded.
“This is the appeal decision. You’re saying they can appeal – this is the appeal decision that I’m talking about,” the reporter said. “And here’s the March 4 letter saying ‘we’re not going to give you this treatment.’”
“I can’t speak to what you’re holding in your hands,” Williams said. “Again, this appeals process has multiple layers of it. I’m not sure where we are in this process.”
A mentally disabled, wheelchair-bound woman classified for work?
When Janice Allen called WBTV to share her story, she was in the middle of a more than six-month-long fight to get the one-on-one treatment her daughter’s doctors say is necessary to help her daughter.
Allen’s daughter, Ashleigh, is 32. She is severely and profoundly disabled, non-verbal and confined to a wheelchair.
Despite that, records show, Cardinal classified her in a group of patients that are capable of preparing food and obtaining employment.
The classification, known as ‘Support Level D’, dictates the amount of state funds Cardinal must set aside to pay for Ashleigh’s care. The more advanced the support level, the more money that must be set aside.
Cardinal authorized Ashleigh to have full-time care for a period but that ended when she had to be re-evaluated in the summer of 2019.
Instead of re-authorizing the individual care Ashleigh had previously, Cardinal approved her for care in a group setting, something Allen said isn’t feasible for her daughter.
“It was almost like ‘I don’t believe you,’ but everything is written right there,” Allen said of her meeting with Cardinal staff.
“They’ve always tried to put her in a group setting,” Allen explained “You require so much hands-on. We’re sitting here now but you have to monitor her: she has startles, she jumps, she drools.”
Allen had Ashleigh’s doctor write a letter stating she needed full-time care on an individual basis but Cardinal has still required Ashleigh to receive some care in a group setting.
Williams, the Cardinal COO, defended the decision in his interview with WBTV.
“One of the key goals and outcomes for individuals is being able to independently function in the community,” Williams said, without acknowledging Ashleigh Allen is incapable of functioning on her own.
Ultimately, Williams said, the Cardinal staff is clinically trained and can be trusted to make critical decisions about medical treatment for some of the community’s most vulnerable patients.
“We absolutely can be trusted,” Williams said. “And we ask that you also trust the process.”