Howard M. Talenfeld, Esq. Rayni A. Rabinovitz, Esq.

htalenfeld@cftlaw.comrrabinovitz@cftlaw.com

954.492.4010

Using Experts to Gain, Maintain & Negotiate Services for Youth with 

Disabilities: Disarming Opposing Experts & 

Leveraging Your Experts

Using Experts to Gain, Maintain & Negotiate Services for Youth with 

Disabilities: Disarming Opposing Experts & 

Leveraging Your Experts

Barriers Disability Advocates Face

Eligibility 

Waiting Lists

Amount, Duration & Scope 

Permanency & Adoption Subsidy

Life Care Plan & Special Needs Trust

Utilizing Your Expert to Make You The Expert!

I. Identifying Experts

II. Paying Experts

III. Preparing Experts and Yourself

IV. Daubert

V. Direct and Cross Examination Tactics

VI. Case Studies

A Road Map

Identify

Locate

Select

I.   Identifying Experts

Pro Bono or Reduced Rate HB 561/SB 972 – Attorneys for Dependent Children with Special Needs Passed April 

30, 2014 Requiring that an attorney not acting in a pro bono capacity be adequately compensated

for his/her services & have access to funding for certain costs Fees & Due Process Costs:

Children in or being considered for placement in skilled nursing facilities: $4,500 per child forattorney fees; $5,000 per child for due process costs

All other categories: $1000 per child for attorney fees

But have no fear because . . . Statutory maximum fee can be exceeded “when applied to cases involving extraordinary 

circumstances and unusual representation.” Makemson v. Martin County, 491 So.2d 1109 (Fla. 1986) – attorney fees

Visit JAC website, “Guide to Obtaining Due Process Costs” ‐https://www.justiceadmin.org/faq/Training%20Modules/GuidetoDueProcessCosts%209‐2010.pdf – due process costs

Register with  www.F4CF.com, Expert Tab for further resources

II.   Paying Experts

Research the disability

Request & review all records

Know all rules

Have expert evaluate child

Review expert’s opinion & basis for opinion

Discuss opposing side’s theory of case

III.   Preparing Experts & Yourself

Frye’s General Acceptance dismantled

Daubert’s Gatekeeping Obligations

Fla. Stat. § § 90.702, 90.704, & 90.705

IV.   Florida Embraces Daubert

(1) Whether the theory or technique in question can be and has been tested; 

(2) Whether it has been subjected to peer review and publication;  (3) Its known or potential error rate;  (4) The existence and maintenance of standards controlling its operation;  and 

(5) Whether it has attracted widespread acceptance within a relevant scientific community

Daubert Gatekeeping Obligations

Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993) Kumho Tire Co. v. Carmichael, 526 U.S. 137 (1999)

Post Traumatic Stress Disorder (PTSD) Reactive Attachment Disorder (RAD) Autism Spectrum Disorders (ASD) & Social Communication Disorder (SCD)

Disruptive Mood Dysregulation Disorder (DMDD)

Intellectual Disability (ID)

Notable Changes in DSM‐V

V.   Direct & Cross Examination Strategies

Tell a story Rely on rules & records to identifybasis for opinion with “ReasonableMedical Probability”

Establish expert’s credibility Discount opposing side’s case directlyor implicitly

Direct Examination Tactics

Cross Examination Methods

1. Attack weakness in expert’s qualifications & credibility

2. Seek favorable concessions 

3. Frame questions quoting the Rules 

4. Attack expert’s knowledge of child’s records & the rules

VI.   Case Illustrations

Eligibility for Services:Webb v. APD, 939 So. 2d 1182 

(Fla. 4th DCA 2006)

Background: 

J.W. in foster care since age 

History of left brain injury, emotional dysfunction, depression, behavioral problems & long juvenile arrest record

Evaluated twice before applying for APD services

Evaluation 1 (1997): Verbal IQ score of 66, performance IQ score of 81, full scale IQ of 71

Evaluation 2 (2003): Verbal IQ of 66, a performance IQ of 75, and a full scale IQ of 69 

Webb v. APD

Facts:  2004:  DCF requested APD Medicaid waiver services for J.W. 

APD requested 3rd evaluation, by Dr. W.

Evaluation 3: Verbal IQ of 77, Performance IQ of 91, Full scale IQ of 82. Concluded was not “mildly mentally retarded” & that his lack of functional skills resulted from emotional disturbance, not MR

Evaluation 4: Dr. A., Verbal IQ of 66, performance IQ of 81, full scale IQ of 71

APD denied waiver request based on Dr. W’s evaluation

J.W. appealed

Hearing officer concluded ineligible, not DD as defined by APD, based on Dr. W’s evaluation

Webb v. APD

Identify  Locate  Select

Webb v. APD: Finding The Expert

4th DCA holding: Hearing officer relied on incorrect legal standard & improperly based his ruling solely on one full scale IQ score.  J.W. eligible for APD! 

APD’s eligibility requirements for ID/MR now . . .  “A single test or subtest should not be used alone to determine eligibility . . . 

If a person has significantly different scores on different scales of a test or tests, or a great deal of variability on subtest scores of an IQ test, the full‐scale score may not indicate mental retardation and should not be relied on as a valid score . . . may include review of school records, school placement, achievement scores, medical records, medication history, behavior during testing . . .” F.A.C. 65G‐4.017(3), as of 5/16/12. 

Webb Results

Cross Examination Tactics: Show Bias

Moving up the Waiting List:E.S. v. APD

Case No. 09‐5771 APD (2009)

Background & Facts:  Born 9/20/72 Medical History:  Visual, motor, communication and processing deficits Hospitalized for injurious behaviors Declared incompetent

History of Diagnoses: 1990 ‐ 1994: 6 doctors diagnosed with autism, infantile autism, autism disorder, or spectrum autistic disorders

1993: 1 doctor diagnosed with Asperger’s APD denials: March 1993 March 2007, Age 35, applied July 18, 2006

E.S. v. APD

Identify  Locate  Select

E.S. v. APD – Locating Experts

Direct Examination:Expert Establishing Medical Criteria

What Can You Do When The Opposing Expert. . . ?

Has only diagnosed a handful of children with the disability at issue

Has never treated an individual with the disability at issue

Has never written nor published any material regarding the subject of the disability

Has no knowledge of the diagnostic criteria for the disability under the relevant DSM‐V diagnosis or Florida statutory definition

Has never met the client

Has never conducted a clinical assessment of the client

Has never obtained nor reviewed the raw data or records of any of the client’s treating psychiatrists/psychologists

Discrediting the Opposing Expert

Approved for APD DD HCBS MedicaidWaiver

Achieved crisis intervention status tomove up waiting list

APD applied retroactively from thedate she first applied rather than dateservices approved

Medicaid paid for Intermediate CareFacility (ICF) Placement

E.S. v. APD Outcome

Amount, Duration & Scope:K.G. v. AHCA, 

Appeal No. 12F‐03716, July 10, 2013

Background: Medical conditions: Marshall‐Smith Syndrome Diagnoses of micrognathia, hypotnia, reflux, chronic lung disease,developmental delay, seizures, hirsutism, scoliosis & muscle spasms

Fed through gastronomy tube (G –tube) Has tracheostomy (trach) to facilitate breathing Has ventricular peritoneal (VP) shunt Non‐verbal & Non‐ambulatory

Private Duty Nursing (PDN) services ‐Medicaid (AHCA) since birth Every 6 months, submits Plan of Care requesting PDN hours Began w/22 hr/day AHCA cut PDN hours every certification period 2006 & 2009: AHCA denied PDN hours request, but settled and approved

requested hours before hearing

K.G. v. AHCA

6 am : wake up, nurse leaves. Attend to K.G. until day nurse arrives at 9:30 am.

In between this time, while attending to K.G., I have to organize bedroom, make breakfast, clean up kitchen, check K.G.’s weekly schedule for any doctors appointments, get dressed for work

I get home from work between 6:15 pm and 6:30 pm. I attend to K.G., until night nurse arrives at 7:30pm.

For about 20 minutes, I report to the night nurse, about K.G.’s day.

After reporting, I prepare dinner.

After dinner I clean the kitchen. Then I sit down, and go through bills for about 30 minutes.

After this I get ready for bed, I usually try to get settled down between 10 and 10:30 pm

Identify  Locate  Select

K.G. v. AHCA: Locating Experts

Facts: 

2011: (Age 11)

18 PDN hours from LPN Mon–Fri; 15 hours Sat; 11 hour Sun throughMedicaid (AHCA Circuit 11)

Submitted request for 24/7 nursing from RN to AHCA/eQ Health Solutions

AHCA/eQ Health Solutions partially denied request by denying 24/7 RNservices, but approved current hours

K.G. appealed for 3rd time

Issue: Whether the respondent’s action to partially deny thepetitioner’s request for 24/7 RN service hours was correct

K.G. v. AHCA

K.G. v. AHCA

eQHealth Physician Reviewer’s “Notice of Outcome”

“The current request is for RN 24 hours/day. Theprovider has offered no new medical informationto support the switch from an LPN to an RN. Assuch, the request is denied because an LPN canperform the necessary duties . . .”

Letting the Expert Make YOU the Expert

K.G. Hearing Transcript, December 14, 2012, 102:15‐103:4

Testimony of Plaintiff’s Registered Nurse Expert 

Cross Examination:Attack Expert’s Qualifications

Cross Examination:Establish Area of Consensus

Cross Examination:Attack Expert’s Credibility

The End Result

24/7 PDN by RN approved

AHCA amends language inFlorida Medicaid Home HealthCoverage & Limitations Bookto not require parents toparticipate to the fullest extentpossible in performing skilledinterventions that normallywould be provided by licensednurse

‐March 2013

Achieving Permanency & Facilitating Adoptions: The Case of K.S.

Background:  Victim of Shaken Baby Syndrome and egregious physical abuse

Medical conditions:  Encephalopathy; Seizure Activity; Cerebral Palsy; Intracranial Hemorrhage; Visually Blind/Cortical vision deficit; S/P Diabetes Insipidus; Adrenal Insufficiency; Scoliosis; Hearing Loss; Microcephaly; Hypertonia; Heart Murmur; Reactive Airway Disease; Gastroesophageal reflux diseases; Spastic Quadriparesis; Contractures

Placed with Medical Foster Mother, former nurse, at 2 months

The Case of K.S.

Facts:

Foster mom wants to adopt but needs:

Medicaid DD Waiver benefits

Increased Adoption Subsidy – F.A.C. 65C‐16.013

Home modifications to stairs & bathroom

Medically necessary procedure to treat CP & Spastic Paralysis: Baclofen Intrathecal Trial

Wheelchair Accessible Van

The Case of K.S.

The Case of K.S.Locating Experts

Identify  Locate  Select

The Case of K.S.Utilizing Expert Reports

Maintenance Adoption Subsidies

$5,000 annually ($416.66 per month)– Fla. Stat. § 409.166(4)(b)

May be negotiated up to 100% of statewide standard foster careboard rate, cannot exceed standard foster care board rate forwhich the child was eligible as a foster child, unless exception isgranted by the Secretary

– F.A.C. 65C‐16.013

How to get increased subsidy?

Continuum of Care/Life Care  Plan Cost Summary

Submitted report to ChildNet, DCF, AHCA & APD

End Result

Obtaining Life Care Plan & Special Needs Trust: 

C.A.F. v. DCF, 11th Judicial Circuit, Case No: 02‐30192 CA 13

Background: C.A.F. born 12/25/90 Removed from home at age 8 due to allegations of neglect, physical and 

sexual abuse, and parental substance abuse “. . . soils his clothes every day and forced to be in it  because mother unable 

to be located. . .” ‐ Abuse Report 1996 2/1998 & 5/1998: Baker Acted twice for suicidal tendencies & uncontrollable 

behavior 9/1998 Diagnosis:  ADHD; PTSD; DD NOS – Dr. D. 10/1998 Diagnosis: Mild Mental Retardation (MR), eligible for 

Developmental Disabilities Program (now APD) services, receipt of services rendered by DCF – Dr. S.

10/1999 Diagnosis:  PTSD; ADHD; Psychotic Disorder NOS, rule out MR – Dr. D. 

C.A.F. v. DCF

Facts: 10/1998: C.A.F. placed in foster care group home for DD kids Abuse repot C.A.F. physically abused & beaten by staff with belt Abuse report C.A.F. sexually assaulted by another resident daily Abuse report C.A.F. & other children being physically & emotionally abused by staff at facility & subject to bizarre forms of punishment

Abuse report C.A.F. sexually assaulted by adult resident 01/1999: School told C.A.F. caseworker that he smelled of urine, GAL 

complained of high staff turnover in home 10/1999: Psychologist and psychiatrist recommended C.A.F. be placed in 

residential treatment center or STFC home due to severe decomposition in mental status

1/2001: Finally removed from group home  10/2001: Adopted by Mr. F. 

C.A.F. v. DCF

File Civil Claim (12/3/2002)

Negligence 

Violation of Florida’s Bill of Rights of Persons who Are Developmentally Disabled, § 393.13

42 U.S.C. § 1983 Violation of fundamental right to physical safety

Securing C.A.F.’s Future

Statute of Limitations (SOL) expires: 4 yrs (negligence)

But You Can’t File a Claim If . . . 

See Fla. Stat. 95.051; Fla. R. Civ.P. 1.210

SOL tolled for a minor child:

Parent, guardian, or guardian ad litem does not exist; or

Adult has an interest adverse to the minor

S.A.P. v. State, Dep't of Health and Rehabilitative Servs., 704So.2d 583, 585 (Fla. 1st DCA 1997)

Securing C.A.F.’s Future

Deposition of Treating Physician 

“[C.A.F.] is a very damagedboy. He has sustained bothemotional and intellectualdamage from his environment.It will take a lot to heal him. . .”

“He was soiling his pantsduring the day, but he didn’tdo it at night.”

Dr. D. Depo, 2/19/2009

Motion Exclude Testimony of Defendant’s Testifying Expert

“Dr. R. rendered an opinion thatC.A.F.’s prognosis is “fair to good.”No generally accepted methodgenerally accepted in the field ofpsychology was relied upon formaking that assessment. . .”

Obtaining a Life Care Plan

Adoptive father passed away Set up SNT, brother appointed astrustee

Why important? SNT allows disabled beneficiary toremain eligible for need‐basedgovernment benefits, such asMedicaid and SSI.

Establishing Special Needs Trust (SNT)

End Results