By Anne C. Woodlen

There are 70,000 Medicaid patients in Onondaga County. Medicaid transportation bills the state $8 million a year. Medicaid dispatch takes 350 ride orders a day. And the Dept. of Social Services administration is spending mega-hours and mega-dollars to prevent Medicaid from spending fifty bucks to take one person—me—to the doctor.

I had to take a TLC wheelchair van to get to the Civic Center for the fair hearing between me and the Onondaga County Dept. of Social Services regarding Medicaid transportation. If I had taken Call-a-Bus, I would have had to sit in the waiting room for two hours, and I just couldn’t—too sick. So I took TLC and only had to wait half an hour. I read my Bible and ate lunch, then my case was called first.

We started at 1:15 p.m. with a female judge with a name so unusual that I can’t begin to tell it. Also in attendance were Zachary Karmen, chief Welfare attorney, and Sandy Kane, his assistant. Zachary Karmen has only been reported to have personally handled Medicaid hearings about twice in the past twenty years, but he’s doing my hearing. I have gotten the Onondaga County DSS investigated by the NYS Office of the Medicaid Inspector General. This is the second time Karmen and I have gone around on the Medicaid transportation issue. The first time, I lost.

The judge dialed the speaker phone to get us into the OTDA recording system, and we began. First, the judge looked in her file and noted that the Inspector General’s Office wants to be kept apprised of the situation. Second, we talked about the letter from my doctor regarding me missing the last hearing because I was sick. Then we talked about reimbursement for my transportation. Then we talked about how come I don’t have a lawyer.

Karmen made some snotty remarks, insinuating that I don’t have a lawyer because I have a lousy personality and nobody will work with me. The judge kept saying she wasn’t going to adjourn this again just because I didn’t have lawyer and saw no way of getting one. I kept saying, “Attorney Karmen’s sitting there with a law book opened in front of him with passages highlighted—I can’t begin to deal with that. This isn’t fair.”

Finally, I said to the judge, “Can I just tell you what happened?” She said yes—first the county would present, then blah-blah-blah, and I said, “But I’m the one who brought the complaint—why can’t I go first?” So she asked Karmen if I could go first and he said yes, so I did.

I had no notes or documents. I was too sick to gather things up at home—I even forgot my appointment book and pen. I started out with, “There was a fair hearing last year, which I lost, so I took Call-a-Bus from August until February, when I got much sicker.” I told my little story. Took maybe five minutes. My doctor called Wayne Freeman, co-owner of Medical Answering Service, LLC, which has the Medicaid transportation dispatch contract for Onondaga County. Then my doctor sent Freeman a new application and a letter. I got transportation for two weeks, then Freeman discontinued it. I got really sick because I couldn’t get to the doctor for treatment, consequently I lost my job, and needed to be hospitalized. Then the case management agency paid for my medical transportation for a month. End of story.

So Karmen asks me a couple questions, one of which was how many times I’ve taken Call-a-Bus since forever. He tells me it was 264 times, then turns it over to Sandy Kane, who probably had to count all those rides. She drags out the judgment from the last fair hearing and reads from it copiously, then starts marching through ancient history. The judge puts up with it for a while, then says something like ‘that was then but this is now.’

This becomes a theme that is brought up repeatedly. Essentially, the county’s argument is that because I once was judged able to take the bus, therefore I am forever and henceforth able to take the bus. Karmen and Kane kept dragging in everything that preceded the decision of August 2006, and the judge kept telling them to forget it—that was over and done with. Move on. Karmen and Kane couldn’t because they had nothing to move on to. After while, I even got up the nerve to interrupt a few times with, “Excuse me, but that’s all the old stuff again.”

They brought in dozens of pages listing my Call-a-Bus records, and one page of Medicaid rides. They go back and forth, up and down, getting everybody confused. Karmen is repeatedly hammering at the idea that she has taken so many bus rides.

Okay, so we come to February 2007 when I got worse. Kane says I refused to tell them what was wrong with me. The judge asks Kane to produce paperwork that they asked me—“No, no, written. Do you have proof that you requested this information?”

Hell, no. They had diddly-squat, so Kane goes out and brings in Wayne Freeman, who’s been sitting outside all this time. Karmen leads him through a whole lot of questions and answers. Wayne and I have had a lot of conversations, and I refused to answer his questions, he says.

The only time I speak up during Wayne’s gig is when Karmen asks him something about DSS Commissioner Sutkowy. I ask for a repeat. I am still not clear what that was all about except for one thing: Wayne has testified to talking with Sutkowy about my transportation. Sutkowy is part of this. Wayne says so.

So we come to my rebuttal. I start with, “I used to drive a car, too, but I got too sick to do that. Likewise, I got too sick to take the bus.” (“Change” being a concept that the county has a really hard time grasping.) I agree that between August and February, I took the bus a lot—I took the bus everywhere (including the doctor’s) because I was doing really well. Then I got worse and needed Medicaid transportation. So the judge and Wayne do a big segue while she tries to figure out the difference between Call-a-Bus and Medicaid.

I take the opportunity to explain to her that I was on Centro’s Accessible Transportation Advisory Council, and Call-a-Bus has been noncompliant with the American’s with Disabilities Act since its inception fifteen years ago. Centro was so noncompliant that the FTA just finished investigating them and is still writing reports and developing action plans. Medicaid is trying to dump its load on Call-a-Bus and they should not be allowed to do it until the FTA Office of Civil Rights has given Call-a-Bus a clean bill of health.

I tell the judge that Wayne and I have had a lot—a lot—of phone conversations over the years, and he repeatedly refused to put anything in writing for me. He’d call up, quote state laws, say this and that and this and that, get me all confused and then, when I needed to know what to do, there wouldn’t be anything in writing that I could refer to.

I also told the judge that the number 264 for Call-a-Bus rides was misleading because the way they report the information, you can’t distinguish between rides taken, rides missed, and rides canceled. Also, the county has finagled the records: they’ve cut off the report so that it doesn’t show that after February whatever, I didn’t take any rides anywhere. I was home in bed being sick. And before that, I never used Call-a-Bus for grocery shopping or to go to church or anything I couldn’t afford to miss—and you just can’t miss doctor’s appointments.

And I tell her—absolutely, unequivocally—that my doctor called Wayne, faxed him the new application, I got rides for two weeks, then Wayne called up the vendor and canceled all my rides.

And I don’t know where I got this brilliant idea, but I took this opportunity to ask Wayne a question I’ve been trying to get answered for years. Wayne, I said, “Who makes the decision about whether somebody gets Medicaid transportation?”

Me and my crack staff, he says.

Who, I ask?

I have a nurse, he says, and a social worker.

How many hours a week do they work, I ask? Are they full-time?

He says he doesn’t know how many hours they work; he’d have to look at the payroll. But they work really, really hard.

I ask, Do they go out into the community to assess patients?

No, he says. But they work very closely with doctors.

I say, “My doctor and I have spent years talking a lot about Call-a-Bus and Medicaid transportation, and he’s never once mentioned getting a call from any nurse or social worker—and I’ve got about fifteen diseases, some of which nobody’s ever heard of.”

Then I ask him why he discontinued my transportation.

Freeman chokes, then spits out, “Because I was directed to by the county.”

“Who in the county told you to?” I ask.

“Zachary Karmen,” he says.

Maybe he says Mr. Karmen. Maybe he says Zach Karmen. It doesn’t matter. He’s just named the man seated on his left, the Onondaga County chief Welfare attorney, the man who has identified himself, in writing, as my enemy.

I say, “So a businessman gives me medical transportation and a lawyer takes it away? And neither of you pay any attention to doctor’s orders?”

It is in that exact moment that I figure I’ve won my case, but the day’s not over yet. In the middle of something, Wayne says, “This is where I differ from Mr. Karmen.” Bottom line is that where Wayne Freeman differs with Zachary Karmen is that Wayne plans to keep giving me rides.

Well, how about that?

We go around in a few more circles. Karmen’s face is red; he’s seething and beating a rapid tattoo with his pen. He asks the judge to reaffirm that aid will not be continued. The judge says, yes, the order of non-continuance will continue.

At this point Wayne—figuratively, at least—throws his arms wide to embrace everybody, looks at me and announces that if I’ll take Call-a-Bus when I can then he will give me Medicaid transportation when I can’t. Never mind what Zachary Karmen says. Never mind what the OTDA says. Never mind what the doctor says.

Wayne is looking at the judge, announcing that we’ve settled this. It’s all taken care of. I am utterly dumbfounded—but not really. The people who run things in Onondaga County have never, ever, realized that when they are spending the state’s money, the state runs the table. Local custom is to make up the rules and never, ever—not once—consider that the somebodies higher up the food chain may already have made rules that apply.

Wayne sits in a hearing in front of an administrative law judge from the New York State Office of Temporary and Disability Assistance and informs her that it’s all taken care of. He’s fixed it. Him and me done struck a deal, and she can go home now. It was a fairly impressive combination of naiveté, stupidity, audacity, disrespect and foolishness.

The judge, in an act of controlled brilliance, ignores him. She says she doesn’t have anything more; do I have anything more? No, no, I’m done, I say. So she asks the county if they have anything more, and Karmen starts asking how many Call-a-Bus rides I’ve taken this week.

I reply that yesterday I took the bus for a 15-minute appointment with the chiropractor and 30 minutes at St. Camillus Rehab, and that I had to leave home at 1:00 and didn’t get back till 6:00. With a catch in my voice, I report that I spent five hours in transit for 45 minutes of health care.

The one thing the judge is absolutely clear about is that she wants to see the medical application and letter from Dr. Ghaly. She says she will leave the record open and Kane is to find it and get it to her by August 6 (or 8, when she returns). I say I will get it from Dr. Ghaly and send it to her, too, not trusting the county any further than the elevator.

An hour and a half after entering the room, we break off contact and retreat to our separate dens.

I have a friend who used to be an Army scout and a known deviant from standard procedure. One day some high muckety-muck wrathfully told him, “You may be God’s gift to the Army, but you should be locked up and not brought out except in case of war!” My friend said he spent the whole day grinning because he hadn’t known that he was God’s gift to the Army.

I feel kind of like that. As awful as the county says I am, they for sure think I’m important.