ZEPHYRHILLS — Approaching the one-year anniversary of their children nearly drowning in the waters of the Erie Canal in Rochester, N.Y., the Clantons received startling news.
The 24-hour home care their daughter, Selah, requires would no longer be funded by their insurance company, Blue Cross and Blue Shield.
Instead, the Clantons said they were being pushed to send their 9-year-old daughter to a nursing home for treatment.
“As long as I’m physically able, that is not going to happen,” Yvonne Clanton, Selah’s mother, said.
On Aug. 15, 2012, the family was in Rochester, N.Y. to mark the fifth anniversary of the successful cornea transplant performed on their son, Sam. That day Sam and his sister Selah, then both 8, were in a side-by-side double stroller as their father, Jon Clanton, pushed.
Seconds after Jon Clanton took his hands off the stroller to check the time on his cellphone, the stroller rolled away and plunged into the Erie Canal. Clanton, with the help of two medical students, saved the children, but Selah, already developmentally delayed, suffered severe brain damage. She has needed extended medical treatment since.
The family has been denied the 24-hour home coverage twice already and are preparing for another appeal, called a formal hearing. Meanwhile, they have since received some much-needed help.
Former state legislator and newly named Pasco County Tax Collector Mike Fasano has stepped in to assist the family. He has had letters sent to Pasco County’s state representatives, including House speaker Will Weatherford of Wesley Chapel.
“This is not acceptable,” Fasano said, “and in my opinion, the decision (the insurance company made) was one just figuring Selah would just be put into a nursing home — and that was absolutely unacceptable ... .”
The agency providing the 24-hour care, Maxim Healthcare, began coming to the Clanton’s Zephyrhills home on Jan. 28 following Selah’s care for six weeks at a Jacksonville facility and about four months in a New York hospital.
In June, Maxim Healthcare received a letter from Blue Cross and Blue Shield denying payment for the care Selah was receiving.
The Clantons appealed the decision, and it was denied. The family then collected letters from all of Selah’s doctors, including therapists and specialists, to file another appeal.
“They were all appalled,” Yvonne Clanton said of Selah’s doctors. “They were, like, basically if this child doesn’t need nursing care, no kid needs it. (The doctors) were very to the point. This child can go into distress quickly. It could be a life or death situation. If anyone needs nursing care, she needs it.”
That appeal also was denied.
Since Jon Clanton, a chaplain at the Zephyrhills Correctional Institution and pastor of Grace Church of Zephyrhills, is a state employee, the denial of the second appeal was authorized by the Florida Department of Management Services, which oversees the state group insurance.
Ryan Duffy, a spokesman for Weatherford, said his office gave a call to Blue Cross and Blue Shield and the Department of Management Services on Monday to ensure the family’s concerns are heard.
The family is eligible for Medicaid, which the three youngest children — Saleh, Sam and Sarah — receive. But their oldest son, Steve, will turn 18 in October, which means there will be one less dependent in the house.
Also, they fear coverage could end because they may exceed income requirements.
“We are one of those families that is very on the edge,” Yvonne Clanton said.
The family says their fight is in line with the lawsuit the Department of Justice filed against Florida in July.
In the suit, the DOJ accused Florida of violating the Americans with Disabilities Act by forcing nearly 200 children in the state with significant medical needs into nursing homes. The department contends those children can and should be served in either their family’s home or “other community-based settings.”
“There’s a scripture that says fight the good fight,” Jon Clanton said. “This is a good fight. But we want to get over it so that hopefully we can get a victory not only for our daughter, but for other children in the state.”