Tragedy of Errors

How Bureaucracy May Have Helped Starve Tyler Walrond

By now most of us are familiar with Tyler Walrond, the two-month-old who starved to death when his mother's efforts to breast-feed him proved insufficient. Tyler's mother, Tabitha, is standing trial for second-degree manslaughter in the Bronx, where the prosecution is painting her as homicidally negligent. Meanwhile, New York's brutally inadequate medical bureaucracy— a system so uncaring it blocked Waldron's efforts to get help at every turn— is getting off scot-free.

The health system's glaring failure— which will serve this week as part of Walrond's defense— has been largely lost to the prosecution's headline-grabbing allegation that Walrond deliberately let her son die to spite her boyfriend, who had ditched her for another pregnant woman. Whatever the true details of the couple's sad story, Tyler should have received health care under New York's medicaid program— but didn't. Because of a series of administrative errors, he never got the treatment that could have saved his life.

Such medicaid "mix-ups"— which both federal and state investigators say are occurring on a large scale as the Giuliani administration whittles welfare rolls— are proving a massive tragedy for children in New York. Nearly 20 percent of New Yorkers under 18, some 370,000 kids, don't have health insurance, according to a recent report by the Commonwealth Fund. Three out of every four of them are eligible for insurance through either medicaid or the state's Child Health Plus program. They're just not enrolled. Tyler's death is the extreme— though not surprising— outcome of this setup.

How can so many kids slip through what's supposed to be a safety net? Walrond's frustrating health care odyssey helps explain. In 1997, Walrond, then 17, was on medicaid and, through that program, had enrolled in an HMO, the Health Insurance Plan of New York. By law, Tyler should have been automatically enrolled in HIP as well when he was born. But, as her lawyer, Susan Tipograph, told the Voice, when Walrond tried to have Tyler examined by a pediatrician at HIP's offices in the Bronx slightly more than two weeks after he was born, HIP workers told her Tyler couldn't see a doctor because he didn't have a medicaid card.

HIP disputes Walrond's account, saying that it has no record of Walrond coming in on that particular day and that company procedures in place at the time "would have assured that Tyler was seen by a pediatrician on a timely basis had Ms. Walrond sought care."

Tipograph says that Walrond then went to see the medicaid officer in the HIP clinic, who in turn sent her to the nearest medicaid office, which was at St. Barnabas Hospital. There, says Tipograph, a worker told Walrond that, since she was on welfare, her medicaid application would have to go through the public assistance office. Walrond then tried to get help from the public assistance office, where her caseworker said she wouldn't be able to process Tyler's medicaid card until he received his birth certificate and social security card.

The Human Resources Administration, which administers public assistance in New York City, declined to comment for this story on the grounds that the trial is still under way.

Walrond was able to schedule an appointment for herself at HIP when Tyler was almost five weeks old. She brought him along, and her doctor commented that the baby looked small. But he didn't examine Tyler. Nor did he— or anyone else— inform Tabitha that, having had both a cesarean delivery and, at 15, breast reduction surgery, she would likely have difficulty breast-feeding.

In mid August, about six weeks after Tyler was born, Walrond received his social security card and birth certificate and made an appointment with her caseworker. But when she arrived at the Human Resources Administration office on August 21 with Tyler and his documents, Walrond's lawyer says she was told she then had to wait for the medicaid card to arrive in the mail. (The worker also commented that Tyler was a "beautiful baby" at that time, according to Tipograph.)

Six days later, Tyler Walrond died, never having had a doctor's appointment. Two medicaid cards arrived for him about two months after his death. Both had his name spelled wrong. An HIP membership card in his name arrived roughly five months after that.

If such a tragedy of errors is inexcusable, it's not uncommon. Elizabeth Benjamin, a Legal Aid attorney, says she frequently handles cases in which infants either never make it onto medicaid or are inexplicably— and illegally— bumped out of the program in the first year of life. Benjamin handled the case of Tatiana Cheeks, another young black woman who was charged with homicide last spring, when her breast-feeding baby died of malnutrition. Charges against Cheeks, who was turned away from New York Methodist Hospital because she didn't have either medicaid or a $25 appointment fee, were eventually dropped.

In Walrond's case, Tipograph thinks charges never should have been brought in the first place. "Tyler Walrond's death was tragic beyond words and preventable," says Tipograph, who feels many people share moral responsibility, including Tabitha and her mother, the family of the father, HIP, and public assistance. "To decide that she should be held criminally responsible given [these] other factors seems wrong."

slerner@villagevoice.com

 
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