WASHINGTON -- In the past few months, Republican presidential nominee and former Massachusetts Gov. Mitt Romney has argued that repealing President Barack Obama's health care reform law would not make a difference to most uninsured. After all, they can always go to the emergency room.
"If someone has a heart attack, they don't sit in their apartment and die,” Romney told "60 Minutes" in a September interview. “We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care."
When pushing his own health care law as governor, Romney argued against relying on hospital visits as a safety net. Emergency room care also cost him a very public legal defeat during his term. The presidential candidate has a thick court file detailing just how inadequate emergency rooms can be for the most vulnerable.
For much of his time in office, Romney fought a class-action lawsuit known as Rosie D. Named for the lead plaintiff, the case was filed in 2001 in an effort to force Massachusetts to provide home-based mental health services for children. The case argued that too many of the state's children -- on Medicaid for various mental health issues such as autism, bipolar disorder and post-traumatic stress disorder -- were being unnecessarily warehoused in institutions and spending too much time in emergency rooms.
The children became known as “stuck kids.”
Instead of working toward a policy fix, the Romney administration chose to take the case to trial. The evidence showing an inadequate mental-health system was overwhelming and well known at the time.
In 2004, Mary Ann Tufts had taken her three adopted daughters, who were struggling with severe mood disorders, to the emergency room so many times that she sold her house to move closer to the hospital. The move, she told The Huffington Post, allowed Tufts and her husband to walk to the ER and take shifts while waiting for services. The ER waits for the children could last for days before they got treatment, Tufts said. "If we had to be waiting in the ER, one of us could be home with the other two daughters,” Tufts explained.
Tufts said she took her daughters to the ER when their auditory or visual hallucinations flared up. The girls would sit among drunks, drug addicts and accident victims, she said.
“The general average would be two to three days,” Tufts said of the ER waits. “I know some families that had five, six, seven days.” Her longest wait with one of her daughters was a wait that lasted close to five days. “You don’t sleep. You don’t eat. You are sitting there thinking [my daughters] are getting worse and worse. Will they be able to come back from that?”
Elaine Arsenault told HuffPost that for every six emergency room visits for her adopted daughter Britney, she'd be admitted once. She and her family would usually have to wait half a day before they would be told whether they'd be admitted or not, she said. “You could be there for 12 hours and they’d be like ‘Oh, we’re not going to admit her,” she recalled. The visits began in 2003 when Britney was 11.
Once, her daughter, who had been diagnosed with post-traumatic stress disorder and depression, was stuck in the ER for two days. “They’ll put you in a room with a bed and a chair,” Arsenault said of that 48-hour wait. “You can sleep in the chair.”
A Huffington Post review of the "Rosie D." court documents and the stories of patients and their families together show that mental-health services under the health care system championed by Gov. Romney were often not worth the wait. The ER visits didn’t lead to better care or more consistent services. Too many of the children ended up in yet another locked room with yet another therapist. Or worse -- with patchwork outpatient services. Massachusetts' mental-health system, fragmented and inefficient, offered few good choices. “It made the kids feel like no one cared, that they were not a priority for anybody,” explained Lisa Lambert, director of the state’s Parent/Professional Advocacy League.
Meri Viano told HuffPost that her son, who had been diagnosed at the time with post-traumatic stress disorder and suffered hallucinations and suicidal thoughts, sat in a hospital for five months waiting for a more appropriate placement. The hospital was more than an hour from home. “It was just exhausting,” she said. “He was a stuck kid. There just wasn’t a placement. There wasn’t the beds. There wasn’t the community services that I could get to bring my kid home.”
Steven Schwartz, lead attorney for those who sued Massachusetts, noted that the wards were costing the state as much as $800 a day -- Romney was wasting $70 million a year on these unnecessary institutionalizations, he said.
“It was about breaking up families and removing kids rather than helping families," Schwartz said. "Kids shouldn't have to choose between treatment and staying in school, or between treatment and living with their mom."
The Romney campaign did not respond to a request for comment.
The Romney administration chose to fight the case in court. Not only was it a costly decision, but an out-of-date one -- many mental health experts had long moved away from Massachusetts' chaotic system, which emphasized costly hospital stays over less expensive, often more successful “wraparound” services that worked to keep children at home.
The U.S. Surgeon General criticized such hospitalizations like residential treatment centers (RTCs) for patients suffering from mental-health issues in a widely-circulated report in the late '90s, calling them one of the most-expensive, least effective forms of care. "In the past, admission to an RTC has been justified on the basis of community protection, child protection, and benefits of residential treatment," the nation's top health official wrote. "However, none of these justifications have stood up to research scrutiny."
A few years before the surgeon general’s report, in response to the skyrocketing costs of residential treatment, Virginia passed the Comprehensive Services Act for At-Risk Youth and Families. Recognizing that kicking the RTC habit required cooperation across bureaucracies, the law provided significant monetary incentives for local stakeholders -- child welfare, mental health, juvenile justice, the courts -- to work together. Wisconsin’s biggest city launched Wraparound Milwaukee as a way to cut down health care costs and to keep kids out of hospitals. In 1995, 400 of its kids were in residential settings. By 2011, that number had dropped to 80.
Arsenault's daughter, Britney, now 20, remembered the emergency rooms as the first stop in the challenging, often frustrating world of mental health care. To her, the ER seemed like a set-up. "They were setting me up to get me more mad," she explained. "To make me wait."
Inevitably, the emergency rooms led to psych wings. She said she needed comfort and compassionate caregivers. Instead, when she got mad, orderlies held her down until she bruised or blacked out, she described. Or stuck a needle in her and restrained her chemically, she said, to the point where she couldn't open her eyes or leave her bed. She said she felt, "like a zombie."
In one six-month stretch, Britney was moved seven times. She was just 15 years old. "I had no one to talk to," she explained. "I felt really alone ... I don't think I did cope with it. It made me really angry that they kept moving me around."
At least four times a month, Elaine Arsenault would visit Britney in a psychiatric facility. The visits depended on Britney’s behavior that week. If she had a rough time, the visits were cut short and supervised, Arsenault described. There were few good weeks. Sometimes, they’d reunite under the watch of a therapist or social worker, she said. Good visits meant huddling in waiting rooms with boxes of torn-up games with pieces missing.
In rooms dirty with food-stained rugs, Arsenault and her daughter would sit on ripped couches. In their silences, they’d stare out of the windows fortified with iron bars, she described. “When I would see her, we would spend so much time trying to reconnect,” Arsenault said. “It felt like I was losing her more being separated.”
In letters to her mother, Britney didn't see the system as dysfunctional. Only herself. "I wish I never messed up because their [sic] was a lot of family stuff that I missed," she wrote to her mother. She said that she saw each new move as her fault.
"This year was the hardest of all of the years I have had," she wrote in another letter. "I have cried. I have got restrained. I have yelled and screamed. I have hit people. It's just been really hard with out [sic] support."
"I hate myself," Britney wrote in another letter, after years of hospitalizations. "I wish I was never born."
After Romney held his ground and fought the Rosie D. case in court, a federal judge rendered a stunning verdict to the governor: The self-described turnaround expert of private equity's corporate world needed to fix a system intent on saving the state's most troubled. U.S. District Judge Michael Ponsor slammed the Romney administration for hurting "the neediest of the needy."
"This is not a close case," Ponsor wrote in January 2006. "The absence of these long-term services too often leaves SED [serious emotional disturbance] children with only one option: expensive, clinically unnecessary and damaging confinement in a long-term residential program or hospital, far from home and family." Ponsor called the state's inadequacy "glaring" and "at times shocking in its consequences."
Ponsor ordered both sides to come up with and settle on a plan that would address the mental health system's problems. Romney would leave office in 2007 without a plan in place.
It would be too late for one of Tufts' daughters, Yolanda, who committed suicide in January 2008 at age 16. Before she took her own life, she testified before the state legislature about the gaps in the system for girls like her.
"I think her bad care contributed to her impulsive decision to take her life," Tufts said.
Tufts said her daughter had been hospitalized at least 10 times. They paid out-of-pocket for a psychiatrist whom Yolanda trusted. But then the psychiatrist quit the practice, and Yolanda never found a suitable replacement, she said. The most the state provided for Yolanda was group counseling sessions and a mentor. "She couldn't understand as a young person why she couldn't get what she needed," Tufts explained.
A year after her daughter's suicide, the state passed "Yolanda's Law," a bill that sought to improve mental-health services for roughly 100,000 Massachusetts children.