Opinion ID: 2629189
Heading Depth: 1
Heading Rank: 2

Heading: Carmen Campbell v. Department of Social & Health Services

Text: On appeal to the Department of Social and Health Services (DSHS) Board of Appeals, the review judge modified the administrative law judge's (ALJ) findings of fact. None of the findings, as modified, have been challenged, and therefore they are verities on appeal. Postema v. Pollution Control Hr'gs Bd., 142 Wash.2d 68, 100, 11 P.3d 726 (2000); Hilltop Terrace Homeowner's Ass'n v. Island County, 126 Wash.2d 22, 30, 891 P.2d 29 (1995). Carmen Campbell was born on June 14, 1994. She has been diagnosed with early onset kyphoscoliosis, also referred to as progressive scoliosis. After unsuccessful treatment at the Shriners Hospital in Spokane, Carmen was referred to Dr. Robert Campbell at CHRISTUS Santa Rosa Children's Hospital in San Antonio, Texas, a founder of the Titanium Rib Project. Due to significant costs anticipated with multiple surgeries, associated after-care, and travel, he would not treat Carmen unless she had insurance. Carmen's mother's insurance carrier initially declined to cover the costs because the treatment was experimental. The United States Food and Drug Administration (FDA) has since approved the Titanium Rib Project and there are over 100 children nationwide participating in the project at three sites San Antonio, Boston, and Philadelphia. [1] Carmen's mother then applied to the Department for services for Carmen. Carmen was determined to be eligible because she had developmental delays and was under six. As a result, Carmen also became eligible for Community Alternative Program Services (CAP services), which allowed her to receive medical coupons (Medicaid) without regard to her mother's income. Carmen's mother's income is too high for Carmen to be eligible for supplemental security income (SSI) benefits. Carmen had undergone 13 to 14 surgeries by the time of the administrative review, roughly twice a year, and is expected to need about two surgeries a year until her growth ceases. Carmen has also been diagnosed with thoracic insufficiency and asthma, both secondary to her progressive scoliosis, heart irregularities (not serious), some hearing loss, and vision problems. She attends a private school and is age appropriate in her physical and academic development. Clerk's Papers (CP) (Findings of Fact 10) at 10. Carmen's original eligibility for Department services and thus CAP services and the CAP waiver, was based upon being under six and suffering from developmental delay. Under DSHS rules, and RCW 71A.10.020, her continued eligibility depends upon her having a developmental disability as defined in the statute and in WAC 388-825-030 once she reached age six. In June 2001, the Department began the required review of Carmen's eligibility. On July 2, 2001, the Department advised her mother that Carmen's medical condition no longer qualified for Department services. Carmen's mother filed a request for an administrative hearing. In the initial decision, the ALJ concluded that the Department had not reviewed sufficient medical information to deny eligibility and ordered the Department to continue eligibility. The Department filed a petition for administrative review. On October 26, 2001, the DSHS Board of Appeals issued its decision reversing the initial decision. On November 7, 2001, Carmen's mother filed a petition for review of the administrative decision in Spokane County Superior Court. The court determined that under RCW 71A.10.020(3) and WAC 388-825-030 the Board properly concluded that Carmen is not eligible for Department services and denied the petition. Carmen's mother, on behalf of Carmen, appealed to the Court of Appeals pursuant to RCW 34.05.526. That court linked the case with Savannah Hurd v. Department of Social & Health Services and certified both cases to this court, which accepted certification and consolidated the cases.