This is a story about an eight-year-old boy in foster care. A boy we've never met. He exists for us only as a name on a letter questioning his mental health treatment. But his lawyer Janice Wolf wants us to remember Nathaniel is real.
"Some of the things our kids have gone through, you and I could only imagine in our dreams, or nightmares."
Nathaniel described vivid nightmares according psychiatric records obtained by the I-Team. During his first of two hospitalizations at Montevista, Dr. Mark Collins ordered a procedure called a brain spect. It requires the injection of radioactive material to illuminate blood flow in the brain.
Read the legal complaint
In a report to the family court, Collins writes the scan confirms Nathaniel has "severe bipolar disorder."
"I think my concern is that our foster kids are getting not just the best psychiatric care, but proper psychiatric care -- that they're not being mistreated, or experimented on, or used as investigational tools," said Wolf.
The American Psychiatric Association does not accept the use of brain imaging for the clinical diagnosis of children, in part, according to its literature, because of children's sensitivity to radiation and to risk of radiation-induced cancer.
Read a statement from the county about the procedures
Dr. Collins likens the exposure to a common CT scan, "To not look at a child's brain who's had multiple treatments and is not getting better, it would be like if you had a heart attack and I'm saying, ‘you know what, you've had a heart attack before. We know you have a bad heart. I'm not going to do an electrocardiogram on you.'"
Collins argues the scans are a valuable tool to aid in the diagnosis of his sickest patients and insists not everybody gets a spec scan.
A recent Medicaid review by the Nevada State Department of Health and Human Services identified 96 Montevista patients who underwent brain imaging. The majority, according to the state, were kids in the juvenile justice or child welfare systems.
"I've been doing enough of them I see the utility in this. I see how important it is to take a look at these kid's brains. If I was not seeing the benefit, I would not continue to do it," said Dr. Collins.
Wolf however questions the benefit and again points to Nathaniel. A court-ordered psychiatric evaluation of the eight-year-old challenged Collins' diagnosis and noted, "Spect scanning is not yet an accepted diagnostic method. Although it is interesting, it is not yet reliable."
Read a statement from Nevada Medicaid
"We are hoping that at least by raising the concern and raising the issue that others will look also, that people responsible for our kids will take a look at what it is and hopefully support us," said Wolf.
And support kids like Nathaniel whose stories come to life from the pages of a foster care case file.
Only a caseworker stands between a child and a controversial procedure. Collins insists he receives no payment related to the scans. He insists brain imaging will soon be accepted by the psychiatric community. There is certainly evidence he may be right but for now, it remains investigational.
Medicaid does not cover investigational procedures, like brain specs. However these claims slipped through to the tune of more than $33,000. The state has not yet decided whether to seek repayment and has issued a memo reiterating its policy.
