STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
KEEFE JOHN RINI, )
)
Petitioner, )
)
vs. ) CASE NO. 85-0534
) STATE OF FLORIDA, DEPARTMENT ) OF HEALTH AND REHABILITATIVE ) SERVICES, )
)
Respondent. )
)
RECOMMENDED ORDER
Notice was given and on June 7, 1985, a formal Section 120.57(1), Florida Statutes, hearing was held. The location of the hearing was Tallahassee, Florida. Before preparing this recommended order, the transcript of proceedings has been reviewed and the exhibits examined. Attention has also been given to the proposed recommended orders of the parties and the memorandum of law offered by the Petitioner. To some extent those proposals form the basis of this recommended order.
Otherwise the suggested facts of counsel for the parties are discarded for reason that they are irrelevant, immaterial, cumulative or subordinate to facts found in the recommended order.
APPEARANCES
For Petitioner: Peter Ostreich, Esquire
The Governor's Commission on Advocacy for Persons with Developmental Disabilities
Office of the Governor, The Capitol Tallahassee, Florida 32301
For Respondent: John L. Pearce, Esquire
Department of Health and Rehabilitative Services
District II Legal Counsel
2639 North Monroe Street Suite 200-A
Tallahassee, Florida 32303
ISSUES
The issues presented concern the question of whether the Petitioner is entitled to receive dental services to be paid for by the State of Florida, Department of Health and Rehabilitative Services. Through this action the Petitioner questions the Respondent's adherence to Chapter 393, Florida Statutes, especially as it relates to pertinent provisions of Development Services Manual, HRSM 160-2. Petitioner believes the substance of the policy manual and the interpretation given to that document by Respondent constitute arbitrary and capricious denial of Petitioner's entitlement to the provision of dental services. Moreover, Petitioner claims that this manual and the characterization of its application to the present case is contrary to Chapter 393, Florida Statutes, entitled "Retardation Prevention and Community Services Act."1
FINDINGS OF FACT
Petitioner is a thirty-one-year-old profoundly mentally retarded male who engages in a variety of self-stimulating behaviors, such as body-rocking and swaying, head-rolling, finger-play, and giggling and mumbling to himself. Some of the behavioral patterns were in evidence in the course of the final hearing in this cause. In addition to his problems with retardation, Petitioner is blind. Petitioner resides in the home of his mother, who has assumed the responsibility of his care notwithstanding his majority.
Petitioner's income for dealing with his personal needs, to include medical care, is constituted of SSI/Medicaid benefits and SSA/Medicare benefits. The total payments are
$336.00 a month. Mrs. Rini receives $325.00 a month. Among other obligations, the family must pay $250.00 in rent, $100.00 in utilities, and a $15.00 phone charge.
Although it is apparent that the Petitioner is not capable of making judgments about his own affairs, the court has not made a declaration of incompetency, as it would relate to the guardianship of the Petitioner or his property.
The last training program which Petitioner was involved in to address his mental and physical difficulty took place when he was around the age of fifteen. In the fall of 1983 a further evaluation and assessment was made of his condition through the Developmental Services Program of the Respondent. A copy of the habilitation plan which was prepared following this evaluation
and assessment process may be found as Petitioner's Exhibit 1, admitted into evidence. In the course of the evaluation Petitioner was found to need developmental training in all areas of basic self-care and to need mobility training. The provision of home-training services was discussed with Mrs. Rini, the Petitioner's mother. At that time Mrs. Rini was not interested in having those services provided.
In this same evaluation session in November, 1983, the suggestion was made that the Petitioner be referred to the Division of Blind Services. At the point of final hearing, this coordination with the Division of Blind Services had not occurred. Mrs. Rini is still interested in having the Petitioner referred to the Division of Blind Services to provide materials to be used in the home and to arrange for any ophthalmological follow-up that might be necessary.
On the date of November 17, 1983, when the evaluation and assessment was made of the Petitioner's condition and habilitative goals established, Petitioner's dental condition was found to be in a poor state. Some four years before this time Petitioner had been taken to a dentist and had had five teeth pulled in two different visits. He had not returned to the dentist since that time and had not had his teeth brushed on a regular basis following those visits. The habilitative plan in its comments section at page 6 of 14, Petitioner's Exhibit 1, described the Petitioner's teeth as appearing in a dismal condition, which was borne out by the examination of health care professionals. His teeth were found to be decayed at the base of the gum line, with thick and heavy plaque along the inside of all teeth. Mrs. Rini was made aware that the examiner felt that there was some danger of infection because of the extent of the amount of decay. Mrs. Rini responded to this observation by indicating that she would take the Petitioner to a dentist when Petitioner indicated that he was ready to go to a dentist. It was recommended that the Petitioner receive professional dental services to be paid for from his personal resources.
The neglect, which was found by observation of the Petitioner's teeth and gums, was not a circumstance which the Petitioner was capable of responding to. At the point of the November 17, 1983, evaluation Petitioner was not capable of brushing his teeth and had not been trained to allow others to do so. That deficit in his abilities still exists.
Even though the habilitation plan of November 17, 1983,contemplated that the dental care of the Petitioner should
be paid for from his personal resources, it was decided on November 16, 1984, that some dental care would be afforded the Petitioner to be paid for by the Respondent. Respondent, through its employees, considered the circumstance in November 1984 to be an emergency. In effectuating this arrangement an addendum was made to the November 17, 1983, habilitation plan. A copy of that addendum may be found as Petitioner's Exhibit 3, admitted into evidence.
An examination by a Dr. Nissen had revealed that Petitioner was experiencing pain from at least two infected teeth and an arrangement was made to have the Petitioner treated on an emergency basis. The treatment involved the use of general anesthesia, the employment of X-rays, and the correction of the condition. This episode was considered by the Respondent, in the person of its employees who were responsible for Petitioner's case, to be an exception to the Respondent's policy of not providing dental care to retarded clients who reside at home. Approval was given in view of the "severity of the problem" and "depressed level of function" on the part of the Petitioner.
Dr. Craig Gassett had referred the Petitioner to Dr. Nissen, in that the Petitioner could not be treated without the use of a general anesthesia, a procedure which Dr. Gassett could not perform in his dental office. The treatment was done at Tallahassee Memorial Regional Medical Center on November 20, 1984, and involved the extraction of ten teeth under general anesthesia, of which one or more were abscessed or infected.
The Petitioner's teeth were cleaned at that time. Treatment was done in the hospital due to the uncooperative, unmanageable nature of the patient.
In November 1984, at the time of final hearing, Petitioner would not allow for the treatment of his dental needs in a dental office. This is evidenced by the fact that a week before the final hearing the Petitioner had been examined in Dr. Gassett's office and would not sit still for more than about thirty seconds. Obviously, this was not sufficient time to allow even the most routine dental treatment. Petitioner is also unreceptive to provision of daily oral hygiene.
When Petitioner was seen most recently, Dr. Gassett observed that he had ten to fifteen teeth remaining and that they appeared decayed and would become abscessed eventually. Dr. Gassett felt that the teeth that are remaining need to be restored. In particular, periodontal treatment is needed in
addition to the restoration of decayed teeth. Dr. Gassett feels it would also be helpful to replace some of the missing teeth with a prosthesis. At the time of the most recent Gassett examination, the Petitioner was found to have a limited chewing efficiency. Given the nature of Petitioner's condition, he is not a candidate for removable dentures or implants.
Petitioner might possibly be trained to allow for the provision of oral hygiene in his home and to allow dental care to be provided in a dental office, without the need to employ general anesthesia, as described by Dr. Gassett and Dawn Hoffman, who has taught the severe and profoundly mentally handicapped. Per Hoffman, this process of teaching Petitioner to accept daily oral hygiene could take as little as a year or as much as thirty years, or Petitioner might never learn to accept this arrangement. The same kinds of problems that would be associated with daily oral hygiene would be inherent in trying to teach the Petitioner to cooperate in dental treatment in a dental office, according to Ms. Hoffman. It is not reasonable to expect the Petitioner to ever be taught to take care of his own oral hygiene needs. The ability to instruct the Petitioner in daily oral hygiene and having him cooperate with the treatment given by dental care professionals is compounded by his blindness. The condition of the Petitioner's teeth and gums at the time of the most recent examination by Dr. Gassett was a matter occasioned by the neglect of necessary daily care.
In Petitioner's present dental condition, he has a problem with continuing infection and the occurrence of more abscessed teeth leading to the removal of the remaining teeth. If he lost his teeth he would have to live on a soft diet. A soft diet is not preferable when compared to Petitioner's present diet.
At present, given the inability of the Petitioner to cooperate with dental treatment that can be done in a dental office in the typical case, the approach to Petitioner's dental treatment cannot be considered routine. It is not routine because of the setting in which the dental treatment takes place, that is, in a hospital with the use of general anesthesia. On the other hand, the type of care that is being received is considered to be routine in the typical patient. The other distinction compared to a typical patient relates to the degree of dental problems being suffered by Petitioner when contrasted with the typical dental patient. The magnitude of
Petitioner's dental problems are enhanced by lack of daily care.
On November 29, 1984, a further evaluation and assessment was made of the Petitioner's condition. Again, this assessment was made by the Development Services Program. A copy of the habilitation plan that came out of that session may be found as Petitioner's Exhibit 2, admitted into evidence. On this occasion Mrs. Rini, Petitioner's mother, was receptive to the idea of assistance in home training for the Petitioner, although she still expressed some reservation about the success of those efforts at home training. It was determined that home training should be implemented on a trial basis. Thus far, that home training has not been given.
It was pointed out in the session of November 29, 1984, that the Petitioner's mother had applied for services from the Division of Blind Services in October, 1984, and had not received acknowledgment from that organization. As indicated before, this application is still pending and has yet to be followed up by the Respondent.
Another item discussed in the course of the November, 1984, assessment and evaluation conference concerns care for the Petitioner should his mother be unable to keep the Petitioner in her home. Petitioner is on a waiting list for placement in a
residence other than his home, should this placement become necessary due to an inability of his mother to continue the care. This is an ICF/MR referral.
In the course of the preparation of the habilitation plan in the November, 1984, session it was determined that the Petitioner would continue to need dental care under sedation or general anesthesia. The payment of these services was contemplated by the Respondent to be through resources available to Petitioner or through Medicare or Medicaid. In this connection, the Developmental Services Manual, HRSM 160-2, at page 6-6, paragraph 6-8 contemplates that Respondent's social worker assigned with the Petitioner's case shall assist Petitioner's family in gaining access to any available resources from Medicare or Medicaid which might pay for the dental treatment; however, in preparation for the hearing Roger Greentanner, a Human Services Counselor Administrator employed by Respondent, inquired of the local Medicaid office and found that Medicaid would not be willing to pay for the cost of dental works ought by the Petitioner. This same witness, Greentanner, indicated that he was unaware of any follow-up by Respondent on the possibility that the Division of Blind Services could assist in the payment of the dental care at issue. Greentanner also indicated in his testimony that he was uncertain about the scope
of home training contemplated in the 1984 habilitation plan, particularly as it related to training for the oral hygiene needs of Petitioner. In summary, Greentanner points out that the Petitioner's services received from Developmental Services is constituted of the availability of respite care; the possible future residential placement outside the home, and pendency of referral to Division of Blind Services for assistance. In addition, home training is contemplated, but it has not yet been provided.
At the point of hearing a caseworker had yet to be assigned by Respondent to assist Petitioner. Greentanner indicates that the reason the Petitioner has not received any follow-up assistance from Developmental Services is due to staff shortages.
In contrast to the circumstances of Petitioner, who resides in the home of his mother, those clients of the Developmental Services who reside in foster homes or group homes receive dental care pursuant to Developmental Services funding in those instances where they are unable to defray the expense.
Richard Herring, Assistant Director, Developmental Services Program, offered testimony. His responsibilities include training and budget. In his remarks he identified the point of view of the Respondent in its policy choice not to provide payment for Petitioner's dental care. This policy choice is grounded in the Developmental Services Manual, HRSM 160-2, according to Herring. Herring identified that this is a policy choice with universal application but not a product of a duly promulgated rule. This policy choice does not take into account the availability of family resources to pay for dental care. As Herring described it, payment for the dental services would only occur if those needs were "directly related to the developmental disability." This pertains to a phenomenon associated with what can be described as side effects of the client's medication which adversely influences the medical circumstances of a retarded client. The example given by the witness Herring describes the epileptic who is receiving anti- convulsant medication which causes dental problems.
Accordingly, Respondent would pay for treatment of that problem. On the other hand, the provision of dental treatment in other circumstances is not contemplated for payment by the Respondent for live-at-home clients, even though it involves the extraordinary arrangement of placing a patient under anesthesia to achieve treatment that could be afforded in the typical case in a dental office without the use of general anesthesia.
Continuing Herring's remarks, his description of "routine dental services" implies things that are ". . . not sudden in nature." Herring's description of the meaning of the policy, which is further discussed in the conclusions of law to this recommended order, is based upon utilization of the Developmental Services Manual, HRSM 160-2. Herring did not author this document and is unaware whether the author consulted a dentist before drafting the provisions which related to dental care. Herring confirmed that clients who are placed in foster homes or group homes who have similar needs to that of the Petitioner would have their dental needs provided for by Developmental Services. This includes the payment of what is described as routine services, assuming the inability of that person or other organizations than Developmental Services to pay for the cost of those services. In the group and foster home setting, the parents of adults are not called upon to pay for the care of the adult retarded client.
Herring identifies the fact that there are some nine to ten thousand clients of Developmental Services who live at home, of the roughly twenty-two thousand clients served.
Under examination Herring acknowledges the anomalous situation of the Petitioner's losing the balance of his teeth and having to be placed in a setting which makes the Petitioner more dependent on resources of Developmental Services. Herring concedes that, given the nature of the way the present policy of the Respondent is employed, to include the funding arrangement, the agency is not as much in the business of preventing
problems-as it would choose to be. If funds were available, Herring believes that Petitioner's condition might not deteriorate to the same extent that it potentially will and would not end up costing as much money in the future.
The arrangement for the payment of services to those retarded clients who reside in their own homes and those retarded clients who live in group or foster homes or other facilities known as rehabilitation facilities, is by two separate line items in the Respondent's budget. Routine medical and dental care is provided for the group or foster home clients and not for those in their own homes in view of this budget arrangement. The choice not to provide for routine medical and dental care for the home resident is a policy choice by the Respondent, given the difference in the amount of money provided in the budget line item for retarded clients who live at home, which is much less than money provided for retarded clients who reside in group or foster homes or rehabilitation facilities.
If the Respondent pursued a different policy, it would cause the Respondent to request an increase in its budget for the benefit of retarded clients who live at home, which Herring does not feel would be granted by the Legislature.
There is a possibility under Chapter 216, Florida Statutes, to move five percent of the money from the group and foster home budget line item over to the home-residence line item and in HRS District II Herring indicated that seventy or eighty thousand dollars worth of funds had been transferred over from the group or foster home clients' budget to the clients living at home. No distinction is drawn between clients who are children living at home as opposed to those who have reached their majority and live at home, on the subject of provision to pay for the dental care of those clients who live at home.
Herring agrees that the result of the present arrangement in which those parents who choose to have their children reside at home, whether those children are of majority or minority, is a financial penalty against those families when contrasted with the families who choose to have their children live in a group or foster home setting.
The transfer of funds between budget line items would tend to penalize those retarded clients who live in foster or group homes. Moreover, Respondent, due to the funding limitations, has approximately two thousand clients who are on the waiting list for services, in addition to a thousand client who are on a waiting list for placement in group homes.
The budget situation at the time of the hearing, as described by Herring, was a situation in which $3,500 a year was available for each retarded client who lived at home. By contrast, $10,000 is available per year for group home clients, to include the payment of room and board and other services. In intermediate care facilities for the mentally retarded, known as ICF/MR, the cost is approximately $30,000 per client per year for room and board and other services.
Deborah Susan Atkinson, a speech therapist, was the chairperson in the habilitation planning sessions for November,1984. She identified the fact that the payment of the emergency care for the Petitioner in 1984 was an extraordinary arrangement. In Greentanner's experience, no other profoundly retarded client of the Developmental Services Program has ever received dental care when the client resided at home. Atkinson also verged that the traditional payment of dental treatment for
those retarded clients who live at home has occurred only when the treatment was related to the treatment of any side effects of anti-convulsant drugs taken for the underlying condition of the
client.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the subject matter of and the parties to this action in accordance with Section 120.57, Florida Statutes.
Chapter 393, Florida Statutes, known as the "Retardation Prevention and Community Services Act,"
requires that the Respondent afford assistance to an individual, such as the Petitioner, suffering from a developmental disorder. In this instance, that disorder is related to profound retardation. At Section 393.063, Florida Statutes, the Legislature expresses its intention to move away from placement in large state institutions and in the direction of community- based placement. This community-based placement includes the possibility of the retarded client living in his or her own home. It is also emphasized that the least restrictive placement is preferable.
Petitioner is a "client" within the definition of Section 393.063, Florida Statutes. Moreover, he is a "client" entitled to receive services within his own residence as seen in Section 393.063(11), Florida Statutes. His condition has been referred to as that of a profoundly retarded person and that description meets the definitional statement set forth in Section 393.063(23), Florida Statutes, related to those persons who are found to be suffering from "retardation."
In addressing the needs of Respondent's clients, the Respondent must be mindful of Section 393.064(5), Florida Statutes. The Respondent may not transfer funds appropriated for retardation programs unless the Secretary of the Department of Health and Rehabilitative Services is satisfied that programs for retardation and other developmental disabilities are not adversely affected by that transfer and further that prevention services that are being provided by the transfer of those funds are cost-efficient. A transfer is made in accordance with Section 216.292, Florida Statutes. At Section 216.292(2)(a), Florida Statutes, authority is granted for the transfer of five percent of funds between line items within the Respondent's budget. In this instance, that would refer to the ability of
the Respondent to transfer funds from the budget for the benefit of clients who reside in group or foster homes over to the budget account for those clients who reside in their own homes.
In addressing Petitioner's needs Respondent shall do so in keeping with individual habilitation plans as prescribed by Section 393.065(2), Florida Statutes. The goals of that plan include the idea of the most cost-beneficial, least restrictive environment which would accomplish objectives related to clients' services. It also includes the idea of providing " . .
. the most appropriate level of care for the client." In order of preference, Section 393.065(2)(c), Florida Statutes, indicates that a home placement is the most desirable residential setting. At present, home placement is a proper indication as a residence for the Petitioner.
Section 393.066(2), Florida Statutes, requires the Respondent to serve all clients regardless of the type of residential setting where the client lives. Services provided include medical services, which is determined to mean dental services as well. This arrangement is in keeping with Section 393.066(4)(c), Florida Statutes.
Section 393.071, Florida Statutes, allows the Respondent to collect fees for services provided to its clients. This fee collection is envisioned by Section 402.33, Florida Statutes, points out that the payment of charges is not a prerequisite to treatment.
Finally, as envisioned by the "Bill of Rights of Retarded Persons," found in Section 393.13, Florida Statutes, retarded persons, to include Petitioner, are candidates for assistance from the Respondent for specified programs for habilitation and treatment and this includes comprehensive medical care. Under this statement of rights, it is not appropriate to deprive Petitioner of the services based upon
inability to pay.
Taken as a whole, these sections of law which have been described in the preceding paragraphs and the associate provisions of Chapter 393, Florida Statutes, clearly envision the Respondent's obligation to assist the Petitioner in dealing with problems related to his retardation. In theory, this contemplates the provision of payment for dental care should the Petitioner be unable to pay for these services and in the absence of financial assistance for the payment of those
services which might be offered by other reimbursement programs such as Medicare or Medicaid.
The evidence in the case points to the Petitioner's limited financial resources. It further describes a circumstance in which other programs of financial relief are either unavailable or the Respondent has failed to assist Petitioner's family in finding available funding from sources other than Developmental Services. The question thus becomes one of identifying any compelling reason why the Petitioner should not receive assistance for his dental care needs.
Emphasis has been placed upon the fact that Petitioner's mother has only become interested in seeking assistance for the provision of daily oral hygiene, effective the date of the most recent habilitative conference in November, 1984, a point in time at which the Petitioner is experiencing the results of years of neglect of his dental health. In countering this position, Petitioner has pointed out the fact that the Respondent has not followed up on its promise to assist the Petitioner in home setting in trying to learn to cooperate when other persons are providing daily oral hygiene. While these positions are factually correct, they do not tend to satisfactorily address the immediate needs of the Petitioner. Those needs center around saving his remaining teeth, and the implications of the failure to resolve that set of problems. If this goal is not realized and daily care is not instituted, Petitioner's health is endangered, presenting a greater cost in human suffering and attendant costs to society.
Unfortunately, the idea of the theoretical entitlement of the Petitioner to be afforded the services may be a hollow promise, given the budgetary constraints under which the Respondent conducts its operations. Nonetheless, Petitioner is legally entitled to receive support in his home in the attempts at educating him to accept the provision of oral hygiene on a daily basis and to receive dental care which he needs at present and will need in the future. To this end, the Respondent is obligated to examine available funds of the Petitioner to provide for his dental care, to assist in finding other funding for the dental care outside the funds available from the Respondent, or in the absence of that funding, to look to its resources within the appropriations items related to retarded clients who live in their own homes and five percent of the funds available from the appropriations item for those retarded clients who reside in settings such as group or foster homes in addressing Petitioner's client needs. Moreover, Respondent
should institute a program of assisting Petitioner's mother in providing necessary daily oral hygiene, with a view to having his mother ultimately assume that responsibility without the assistance of Respondent's advisors or teachers.
Throughout this case frequent reference has been made to the Developmental Services Manual, HRSM 160-2, in stating the policy choice of the agency on the topic of the provision of dental care for the benefit of the Petitioner. It suffices to say, upon a reading of Chapter 393, Florida Statutes, that this policy manual to the extent that it is contrary to the basic idea of providing equal services for retarded clients without regard for their place of residence, it is an unacceptable policy statement. Further, any interpretation of that policy manual which is contrary to the idea of equal treatment of clients without regard for their place of residence is an unacceptable interpretation of the requirements of Chapter 393, Florida Statutes. This speaks in particular to those provisions of the Developmental Services Manual, HRSM 160-2, at pages 3-1 and 3-2, paragraph 3-2.a (2)(g), which state:
The following are not services provided by the Developmental Services Program:
(g) Routine medical/dental treatment etc., to clients living in their own homes, or residing in facilities for which developmental services does not make payment for basic maintenance, except for the services in support of a habilitative goal.
Likewise, those provisions set forth in the Developmental Services Manual, HRSM 160-2, at page 6-5, paragraph 6-7 are found to be unacceptable to the extent that they prohibit the provisions of care for the Petitioner, in keeping with the format addressed in paragraph 2 of the conclusions of law. The language of those provisions at issue is as follows:
Routine Medical and Dental Examinations.
The Developmental Services Program recognizes the importance of clients having routine medical and dental examinations which may be incorporated in the individual's habilitation plan. (Refer to paragraph 4-6a.(3) and (4)). The provisions
for obtaining these services with Developmental Services funds to insure that the client's needs are met depends upon several factors. The following conditions must be considered in determining when it is appropriate to use Developmental Services funds.
When a client is not residing in a residential facility funded by HRS, medical/dental services will not be purchased unless the medical/dental needs are directly related to the developmental disability.
Medicaid, if available, should always be used for clients when the examination is a medicaid eligible service. Normally, routine medical and dental services are not provided by Medicaid, except for individuals twenty years of age and under.
Documentation must be provided of the unavailability of Medicaid providers if purchased clients services funds are to be used.
Resources available by other Department Programs should be utilized.
The client's habilitation plan must identify the need and before Developmental Services funds are used, the social worker must document that no other resources are available.
Developmental Services must assume financial responsibility for obtaining medical and dental services when a client is receiving residential services, the facility is not responsible and all other resources have been exhausted.
Petitioner's dental needs can be addressed, within the format described in paragraph 2 of the conclusions of law, even if they are not the side effects of the receipt of medication to treat the underlying condition of retardation or other similar disability. Chapter 393, Florida Statutes, recognizes the idea
of treating the dental needs of a retarded client, which needs may be unique to that category of patients, and those needs should be addressed whether brought about as a side effect of the use of medication for epilepsy, etc., or whether routine in nature or other than routine. Moreover, Petitioner's overall dental health is properly regarded as a habilitation goal.
Having considered the facts and in view of the conclusion of law, it is
That a Final Order be entered to this effect:
Respondent shall send a teacher or advisor to the home of the Petitioner for purposes of assisting Petitioner's mother in learning the techniques of providing oral hygiene to the Petitioner, and shall continue to provide that oral hygiene for Petitioner until Petitioner's mother has gained the necessary expertise to perform these tasks. This arrangement contemplates efforts at training the Petitioner to cooperate in these endeavors. This arrangement shall continue until such time that success is gained in the undertaking or it is determined, in the professional judgment of the advisor or teacher, that Petitioner cannot be trained to accept the provision of oral hygiene or the Petitioner's mother ceases to allow this arrangement to be pursued.
Respondent through its staff shall ascertain the ability of the Petitioner to pay for his present dental care needs. In the absence of his ability to pay, Respondent's staff shall assist the Petitioner's mother in finding sources of reimbursement or payment other than Developmental Services funding and as a matter of a final resort shall utilize the resources of the Respondent related to available funds within the budget for retarded clients who live in the home or look to available funding up to five percent as transferred from the budget items pertaining to retarded clients who reside in group or foster homes or similar residences. If funding is not available at this time, Respondent's staff shall continue to make a diligent search for available funding to aid the Petitioner in the treatment of his dental care needs.
DONE AND ENTERED this 19th day of August, 1985, at Tallahassee, Florida.
CHARLES A. ADAMS
Hearing Officer
Division of Administrative Hearings Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301 904/488-9675
FILED with the Clerk of the Division of Administrative Hearings this 19th day of August, 1985.
ENDNOTE
1/ Petitioner has also advanced claims that the agency in this action has violated the equal protection clauses found in the United States Constitution and Article 1, Section 2 of the Constitution of the State of Florida. These are contentions which cannot be addressed in the administrative hearing process.
COPIES FURNISHED:
Peter D. Ostreich, Esquire The Governor's Commission
On Advocacy For Persons With Disabilities
Office of the Governor The Capitol
Tallahassee, Florida 32301
David H. Pingree, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, Florida 32301
John L. Pearce, Esquire
HRS District II Legal Counsel 2639 North Monroe Street Suite 200-A
Tallahassee, Florida 32303
| Issue Date | Proceedings |
|---|---|
| Aug. 19, 1985 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Aug. 19, 1985 | Recommended Order | Human Resource Services should provide dental hygiene assistance to Petitioner, a retarded person; assess Petitioner's ability to pay; and fund assistance if Petitioner is unable. |
