O’FALLON, MO. -- It’s lunchtime at Amanda and Todd Geraghty’s O’Fallon, Missouri home, and that means preparing their nine-year-old son Quinn’s feeding tube. A lifeline for a young life marred by illness since birth.
“That’s when they started doing MRI’s, brain scans and things like that. That’s when they told us he had a stroke in the uterus.” Said Quinn’s mother Amanda Geraghty.
Quinn’s diagnoses include spastic quadriplegic cerebral palsy, microcephaly and a seizure disorder. Caring for him is a 24/7 job.
“We had full-time nursing for two years. In May of this year, they sent us a letter saying that it’s not medically necessary for him to have nursing except for at night.” Added Geraghty.
United Healthcare, Quinn’s insurance provider through Missouri’s Medicaid program, informed the Geraghty’s Quinn’s in-home nursing was being cut from 104 hours a week to 56. It’s care the Geraghty’s relied on following Quinn’s tracheostomy two years ago.
“He needs to be suctioned. For him it’s consistent. He needs to wear an oxygen monitor at night.” Said Geraghty.
You see, Amanda and Todd aren’t just caring for Quinn, they have two other sons, one of whom is autistic. Amanda’s job that includes travel, while Todd stays home dividing his attention among the boys. Without a nurse around during the day, they worry the slightest distraction could leave Quinn unattended and vulnerable.
“The trach can pop out. It does frequently pop out. Depending on how long it’s out it can turn immediately into an emergency.” Added Geraghty.
The Geraghty’s appealed the decision. In June, they received this letter from Missouri HealthNet Assistant Medical Director Dr. Timothy Kling. It references a discussion he had with United Healthcare Chief Medical Officer Dr. Ravi Johar. The topic? Quinn’s May appointment with his pulmonologist. Kling offers information from that visit and nursing notes from April as the basis for upholding the Geraghty’s denial.
But our investigation revealed a different story. Through an open records request, we obtained nursing notes on this case. According to the Geraghty’s attorneys, the state used these notes in its decision to reduce Quinn’s nursing hours. We asked the state, but staff declined to comment on what they called a “closed and confidential” matter. The reports we received detail events appearing to contradict the state’s determination that Quinn is stable at home.
For example, on April 23rd the nurse noted Quinn “requires total care for all body position movements and frequent monitoring of his trach.” She later documented using suction to clear the trach when Quinn was struggling to breathe. On April 24th she twice noted clearing the trach and providing Quinn oxygen because he wasn’t breathing well in his sleep. An April 26th report states how Quinn’s trach came out and was replaced by the nurse.
If the state reviewed these records, the Geraghty’s want to know how officials decided full-time nursing “wasn’t medically necessary” for Quinn. Fox 2’s Mike Colombo requested multiple interiews with state officials, but they were denied by the Missouri Department of Social Services. The Geraghty’s also want to know how Dr.Kling and Dr.Johar, both specialists in obstetrics and gynecology, concluded the reduction in Quinn’s nursing hours should be upheld.
“It’s hard enough to have children in the condition of Quinn and our oldest son. It’s very frustrating that the insurance companies make things that much harder. We just went on our first family vacation ever and our oldest son is 16. It’s something that really bothers me. And that’s because we were able to take Quinn’s main nurse with us.” Added Geraghty.
In a September administrative hearing, the Geraghty’s attorney said Dr. Kling admitted under oath that Quinn does in fact periodically need an oxygen machine when he sleeps. An acknowledgment the Geraghty’s hope will help their fight to restore the nursing care they believe Quinn needs.