Witness says center balances price, care

Expert defends development facility

— A private physician hired by the state in its effort to defend the Conway Human Development Center testified Saturday that providing the same level of care the center provides, but in a lessrestrictive setting, could cost more and limit badly needed services.

“During our tours of the largest providers in the state ... we repeatedly heard less restrictive settings were often unable to meet the needs of individuals” with the level of developmental disabilities as those in the Conway center, said Dr. Ted Kastner of New Jersey.

Kastner testified that theConway center offered a comprehensive array of services in one location, such as 24-hour medical care, occupational therapy, speech therapy, physical therapy, psychiatric services and education.

“It’s all there,” he said.

In community settings, such services are “fragmented and less integrated,” Kastner said.

Saturday marked Kastner’s second full day on the witness stand and the trial’s 18th day. His testimony continued into the weekend because the nonjury trial before Chief U.S. District Judge Leon Holmes was postponed earlier in the week when two attorneys fell ill.

Holmes is hearing the case the U.S. Department of Justice brought against the center in January 2009.

In the lawsuit, the Justice Department claims the state has fallen below federal standards of care at the center and is violating the civil rights of residents by favoring institutions for developmentally disabled adults and children instead of helping them live and learn in the least-restrictive environment possible, as required by federal law. The department wants Holmes to order the state to comply with federal law.

Less-restrictive environments include small group homes, day-service programs and returning patients to their families.

The state maintains that the residents are well-cared for, and that parents and guardians want their loved ones to live at the Conway center. Some parents worry that the Justice Department’s lawsuit could ultimately cause the 50-year-old residential facility to close, leaving their loved ones without a safe place to live.

Kastner told Holmes that federal law required less restrictive environments when appropriate for residents’ needs, but that it does not force parents to “surrender the right to obtain services” in a facility like Conway or a special school.

Slightly more than 500 people live at the Conway center, about 150 of whom are deemed medically fragile and require intensive, around-the-clock care.

During questioning by Thomas York, a Pennsylvania attorney hired by the state, Kastner said Arkansas spends about $290 per day per resident for care at the Conway center.

If those same individuals lived in community programs funded through the Medicaid “waiver” financial-assistance program, which helps families cover costs if they don’t want their loved ones in institutional settings, the cost would be up to $391 a day for at least 80 percent of the Conway center residents, Kastner said.

He also said that rules in the waiver program don’t requirestates to provide a specific level of care in less restrictive settings.

Prompted by York, Kastner also noted that the waiver program limits the number of wheelchairs a person can receive in a lifetime to one and the number of augmentedcommunication devices to one in a lifetime.

Kastner also complained that resident care in less restrictive settings isn’t as well documented as it is in human development centers.

In addition, he said he had no confidence in the federalgovernment’s ability to ensure the health and safety of residents if they move out of the Conway center and into a less restrictive setting in the community.

Cross-examination of Kastner is expected to continue today beginning at 1:30 p.m.

Northwest Arkansas, Pages 7 on 10/04/2010

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