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YA nA FR WwW
ELECTRONICALLY
Bay Area Legal Aid
Michael Keys (SBN 133815) FILED
1800 Market Street, 3" Floor sone tne
San Francisco, CA 94102
T: (415) 982-1300 o4/ (03 /: 2017
F: (415) 982-4243 By-CAROL paliernear
mkeys@baylegal.org Deputy Clerk
Western Center on Law & Poverty
Richard Rothschild, (SBN 67356)
R. Mona Tawatao, (SBN 128779)
3701 Wilshire Blvd., Suite 208
Los Angeles, CA 90010
P: (213) 235-2624
F: (213) 487-0242
rrothchild@welp.or:
mtawatao@welp.org
Attorneys for Petitioners
SUPERIOR COURT OF THE STATE OF CALIFORNIA
IN AND FOR THE COUNTY OF SAN FRANCISCO
CRISTINA LICHTENBERGER and CASE NO.: CPF-13-513157
JANE REDMOND,
Petitioners,
PETITIONERS’ MOTION FOR.
ATTORNEYS’ FEES
vs.
CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES; TOBY
DOUGLAS, Director, California Department
of Health Care Services; DOES 1 - 20,
DATE: April 10, 2017
TIME: 9:30 a.m.
DEPT.: 302
Respondents. Reservation No. 02230410-10
eee
Supplemental Declaration of Jane Redmond in Case No. CPF-13-513157
Support of Petitioners’ Motion for Attorneys’ Fees
SUPPLEMENTAL DECLARATION OF
JANE REDMOND IN SUPPORT OFSupplemental Declaration of Jane Redmond
I, Jane Redmond, of San Francisco, California, say that the following facts, as set
forth in this declaration, are personally known to me. If called as a witness, I could and
would testify under oath as follows:
1, Lama resident of San Francisco, California and have continuously been so
Oo Oo IN DH &F WH
Boe
=- Oo
during this entire lawsuit.
. Lam eligible for Medi-Cal health insurance based upon my low-income and
disabilities. My disabilities include chronic severe pain, lower extremity
peripheral neuropathy and depression. The pain in my both my knees, legs and
lower back is so severe that I cannot do even the most basic tasks like walking,
going up and down steps at my apartment or sleeping without medication to
control the pain. The pain can get so bad that my knees just lock up where I
cannot move for a whole day or more.
. It is my understanding that the State is saying that the SFHP rule requiring me
and all other SFHP recipients to try the listed drugs and show they do not work
before giving Medi-Cal coverage for unlisted medications is part of something
called step therapy. I do not think what the SFHP did to me is any kind of real
therapy.
. It is my further understanding that the State is claiming that the try and fail rule
could have been changed by just a letter. That is not true. In my case alone,
there were multiple opportunities to voluntarily change this rule and it never
happened until this lawsuit forced that change.
. Before 2012, I had been getting my Medi-Cal on a fee for service basis and did
not have any problems with Medi-Cal covering the Lidoderm (also called
Lidocaine patches) described in this declaration to treat my pain. Beginning in
2012, I started receiving my Medi-Cal health care services, including
prescription medications, through the San Francisco Health Plan (SFHP) as partCo mo IY DA eB WN
PNY NY YN RN DY BH Bee ee eB ew eR
eo IU DA A FBS KF SO we AA ARES NH ES
of the State of California requiring Medi-Cal recipients to join a Medi-Cal
health plan.
. In February 2012, Dr. Lynette Leighton, my doctor at the Family Health Center,
requested that the SFHP continue providing Medi-Cal coverage of the
prescription Lidoderm. Dr. Leighton was my primary care physician from about
February 2012 until approximately August 2012. Dr. Leighton submitted a
statement explaining that I was taking opiates and antidepressants and had
already tried other drugs and physical therapy for pain but none had worked.
Dr. Leighton again preseribed Lidoderm as the only treatment which would
control my pain and let me sleep at night in light of my other medications.
. The SFHP denied Dr. Leighton's February 2012 request for coverage of the
Lidoderm. The SFHP said that because the Lidoderm was not on its drug
formulary list, it would only cover it by Medi-Cal if] first tried the drugs on that
list and they did not relieve the pain. The SFHP did not consider what effect the
listed drugs would have on me or if they would be effective in denying coverage}
of the Lidoderm.
. The SFHP said that another physician at the Family Health Center, Dr. Mary
Murphy, had agreed for me to try the listed drugs before Medi-Cal would cover
the Lidoderm. Dr. Murphy told me that since the SFHP would not agree to
cover it with Medi-Cal until I tried the other drugs, she had no choice but to
agree with the SFHP.
. The hearing decision for my appeal denied Medi-Cal coverage for Lidoderm
because I had not tried these other drugs and had them fail: Venlafaxine,
Cymbalta, and Lyrica. Even the hearing officer decided that my doctor had
already diagnosed that the Lidoderm was the only medication which would
properly treat my pain and let me sleep at night. Nevertheless, she still said I
had to try the others and have them fail.. Both the SFHP and the State couldCo ort nunete wWN
10
u
12
13
14
-15
16
17
18
19
20
21
22
23
24
25
26
2
28
onl
have changed the rule instead of enforcing it through this hearing decision but
they did not.
10. Even after the hearing, the State had a chance to voluntarily change the try and
fail rule. Bay Area Legal Aid was able to get a letter from my psychiatrist
explaining that the listed drugs posed a serious risk to my health by worsening
my anxiety, panic attacks, and hypertension. Based upon this additional
evidence, we asked for a rehearing. That rehearing request was denied because
it did not change the fact that the SFHP rule required that I first try the listed
medication before I could get Medi-Cal coverage for the unlisted Lidoderm.
11. After I lost the administrative hearing, I decided that I should follow my doctor
and psychiatrist's advice since they knew my medical conditions better than
anyone else and both had been treating me. As a result, I did not take the listed
drugs offered for Medi-Cal coverage by the SFHP. I am very low income and
do not have any extra money to pay for medications after I pay my basic living
expenses. Even so, I would sometimes take some of this money and pay for
Lidoderm out of my own pocket. When I did that, I could walk and go to my
medical appointments so I saved the Lidoderm for these occasions. When I did
not use Lidoderm because I was saving them for when I had to go out, I was
basically trapped in my apartment. Sometimes my daughter helped me pay for
but she o_ not always afford to do that, TA2 We bake
brad dace eT
de a
12. During this time, Bay Area Legal Aid continued to help me try to get Medi-Cal
coverage for the Lidoderm. Finally in 2015, my new primary care physician,
Dr. Isabel Lee, assisted Bay Area Legal Aid with submitting a form to the
California Department of Managed Health Care explaining why I needed the
Lidoderm. Eventually, after this form was submitted, Medi-Cal started covering}
the Lidoderm, Since then, Medi-Cal has covered Lidoderm.13. Having the Lidoderm on a regular and consistent basis has changed my life.
After Tlost the hearing and until I started getting the Medi-Cal coverage, my
legs hurt so bad I could not even answer the front gate for my apartment
building or go to the building mail box. 1 am now able to get out and go to
appointments without figuring out whether I have rationed some Lidoderm or
not. I am even able to do volunteer work at San Francisco General Hospital
where I had volunteered for many years before having to stop until I got the
Medi-Cal coverage for Lidoderm again. All of this has helped a lot with my
mental health and feeling of well-being. I no longer have to depend on my
daughter to get this medication which made me feel very inadequate as a
mother.
14, Even though I did eventually get coverage of the Lidoderm, I suffered a lot of
pain because of the SFHP's rule that I had to first try its other, listed medications
and have them fail before it would cover the unlisted Lidoderm. ] The SFHP
had medical reports from my physicians and psychiatrist stating that I needed
the Lidoderm during this time but it still enforced its try and fail rule against me,
15. It is my understanding that this lawsuit has resulted in the SFHP no longer being}
able to require that Medi-Cal recipients try listed medications that are
inappropriate or even dangerous before getting Medi-Cal coverage for the
proper, unlisted medication. I think this is a very important result for all who
get their Medi-Cal through the SFHP. Dr. Lee told-me that she had never seen
the SFHP approve Lidoderm before this lawsuit. I now know of other people in
the SFHP besides myself who are getting Medi-Cal covered Lidoderm.
I declare under penalty of perjury under the laws of the State of California that the
il foregoing is true and correct. Executed in San Francisco, California on March 29, 2017.
qauealawarnjol—
Jane Redmond
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YA nA FR WwW ELECTRONICALLY Bay Area Legal Aid Michael Keys (SBN 133815) FILED 1800 Market Street, 3" Floor sone tne San Francisco, CA 94102 T: (415) 982-1300 o4/ (03 /: 2017 F: (415) 982-4243 By-CAROL paliernear mkeys@baylegal.org Deputy Clerk Western Center on Law & Poverty Richard Rothschild, (SBN 67356) R. Mona Tawatao, (SBN 128779) 3701 Wilshire Blvd., Suite 208 Los Angeles, CA 90010 P: (213) 235-2624 F: (213) 487-0242 rrothchild@welp.or: mtawatao@welp.org Attorneys for Petitioners SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF SAN FRANCISCO CRISTINA LICHTENBERGER and CASE NO.: CPF-13-513157 JANE REDMOND, Petitioners, PETITIONERS’ MOTION FOR. ATTORNEYS’ FEES vs. CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES; TOBY DOUGLAS, Director, California Department of Health Care Services; DOES 1 - 20, DATE: April 10, 2017 TIME: 9:30 a.m. DEPT.: 302 Respondents. Reservation No. 02230410-10 eee Supplemental Declaration of Jane Redmond in Case No. CPF-13-513157 Support of Petitioners’ Motion for Attorneys’ Fees SUPPLEMENTAL DECLARATION OF JANE REDMOND IN SUPPORT OFSupplemental Declaration of Jane Redmond I, Jane Redmond, of San Francisco, California, say that the following facts, as set forth in this declaration, are personally known to me. If called as a witness, I could and would testify under oath as follows: 1, Lama resident of San Francisco, California and have continuously been so Oo Oo IN DH &F WH Boe =- Oo during this entire lawsuit. . Lam eligible for Medi-Cal health insurance based upon my low-income and disabilities. My disabilities include chronic severe pain, lower extremity peripheral neuropathy and depression. The pain in my both my knees, legs and lower back is so severe that I cannot do even the most basic tasks like walking, going up and down steps at my apartment or sleeping without medication to control the pain. The pain can get so bad that my knees just lock up where I cannot move for a whole day or more. . It is my understanding that the State is saying that the SFHP rule requiring me and all other SFHP recipients to try the listed drugs and show they do not work before giving Medi-Cal coverage for unlisted medications is part of something called step therapy. I do not think what the SFHP did to me is any kind of real therapy. . It is my further understanding that the State is claiming that the try and fail rule could have been changed by just a letter. That is not true. In my case alone, there were multiple opportunities to voluntarily change this rule and it never happened until this lawsuit forced that change. . Before 2012, I had been getting my Medi-Cal on a fee for service basis and did not have any problems with Medi-Cal covering the Lidoderm (also called Lidocaine patches) described in this declaration to treat my pain. Beginning in 2012, I started receiving my Medi-Cal health care services, including prescription medications, through the San Francisco Health Plan (SFHP) as partCo mo IY DA eB WN PNY NY YN RN DY BH Bee ee eB ew eR eo IU DA A FBS KF SO we AA ARES NH ES of the State of California requiring Medi-Cal recipients to join a Medi-Cal health plan. . In February 2012, Dr. Lynette Leighton, my doctor at the Family Health Center, requested that the SFHP continue providing Medi-Cal coverage of the prescription Lidoderm. Dr. Leighton was my primary care physician from about February 2012 until approximately August 2012. Dr. Leighton submitted a statement explaining that I was taking opiates and antidepressants and had already tried other drugs and physical therapy for pain but none had worked. Dr. Leighton again preseribed Lidoderm as the only treatment which would control my pain and let me sleep at night in light of my other medications. . The SFHP denied Dr. Leighton's February 2012 request for coverage of the Lidoderm. The SFHP said that because the Lidoderm was not on its drug formulary list, it would only cover it by Medi-Cal if] first tried the drugs on that list and they did not relieve the pain. The SFHP did not consider what effect the listed drugs would have on me or if they would be effective in denying coverage} of the Lidoderm. . The SFHP said that another physician at the Family Health Center, Dr. Mary Murphy, had agreed for me to try the listed drugs before Medi-Cal would cover the Lidoderm. Dr. Murphy told me that since the SFHP would not agree to cover it with Medi-Cal until I tried the other drugs, she had no choice but to agree with the SFHP. . The hearing decision for my appeal denied Medi-Cal coverage for Lidoderm because I had not tried these other drugs and had them fail: Venlafaxine, Cymbalta, and Lyrica. Even the hearing officer decided that my doctor had already diagnosed that the Lidoderm was the only medication which would properly treat my pain and let me sleep at night. Nevertheless, she still said I had to try the others and have them fail.. Both the SFHP and the State couldCo ort nunete wWN 10 u 12 13 14 -15 16 17 18 19 20 21 22 23 24 25 26 2 28 onl have changed the rule instead of enforcing it through this hearing decision but they did not. 10. Even after the hearing, the State had a chance to voluntarily change the try and fail rule. Bay Area Legal Aid was able to get a letter from my psychiatrist explaining that the listed drugs posed a serious risk to my health by worsening my anxiety, panic attacks, and hypertension. Based upon this additional evidence, we asked for a rehearing. That rehearing request was denied because it did not change the fact that the SFHP rule required that I first try the listed medication before I could get Medi-Cal coverage for the unlisted Lidoderm. 11. After I lost the administrative hearing, I decided that I should follow my doctor and psychiatrist's advice since they knew my medical conditions better than anyone else and both had been treating me. As a result, I did not take the listed drugs offered for Medi-Cal coverage by the SFHP. I am very low income and do not have any extra money to pay for medications after I pay my basic living expenses. Even so, I would sometimes take some of this money and pay for Lidoderm out of my own pocket. When I did that, I could walk and go to my medical appointments so I saved the Lidoderm for these occasions. When I did not use Lidoderm because I was saving them for when I had to go out, I was basically trapped in my apartment. Sometimes my daughter helped me pay for but she o_ not always afford to do that, TA2 We bake brad dace eT de a 12. During this time, Bay Area Legal Aid continued to help me try to get Medi-Cal coverage for the Lidoderm. Finally in 2015, my new primary care physician, Dr. Isabel Lee, assisted Bay Area Legal Aid with submitting a form to the California Department of Managed Health Care explaining why I needed the Lidoderm. Eventually, after this form was submitted, Medi-Cal started covering} the Lidoderm, Since then, Medi-Cal has covered Lidoderm.13. Having the Lidoderm on a regular and consistent basis has changed my life. After Tlost the hearing and until I started getting the Medi-Cal coverage, my legs hurt so bad I could not even answer the front gate for my apartment building or go to the building mail box. 1 am now able to get out and go to appointments without figuring out whether I have rationed some Lidoderm or not. I am even able to do volunteer work at San Francisco General Hospital where I had volunteered for many years before having to stop until I got the Medi-Cal coverage for Lidoderm again. All of this has helped a lot with my mental health and feeling of well-being. I no longer have to depend on my daughter to get this medication which made me feel very inadequate as a mother. 14, Even though I did eventually get coverage of the Lidoderm, I suffered a lot of pain because of the SFHP's rule that I had to first try its other, listed medications and have them fail before it would cover the unlisted Lidoderm. ] The SFHP had medical reports from my physicians and psychiatrist stating that I needed the Lidoderm during this time but it still enforced its try and fail rule against me, 15. It is my understanding that this lawsuit has resulted in the SFHP no longer being} able to require that Medi-Cal recipients try listed medications that are inappropriate or even dangerous before getting Medi-Cal coverage for the proper, unlisted medication. I think this is a very important result for all who get their Medi-Cal through the SFHP. Dr. Lee told-me that she had never seen the SFHP approve Lidoderm before this lawsuit. I now know of other people in the SFHP besides myself who are getting Medi-Cal covered Lidoderm. I declare under penalty of perjury under the laws of the State of California that the il foregoing is true and correct. Executed in San Francisco, California on March 29, 2017. qauealawarnjol— Jane Redmond