When Bryan Stow's family considered where their critically injured son and brother would receive therapy, Bakersfield was not at the top of their list.
"Before we had even gone there we basically said, 'That's not going to happen, it's way too far,'" said Bonnie Stow, one of Bryan's sisters.
Stow, a San Francisco Giants fan, suffered major injury to the frontal lobe of his brain after he was beaten at Dodgers Stadium in March 2011. Stow worked as a paramedic in Santa Cruz County before the beating and his family lives in the Bay area; The Centre for Neuro Skills, a post-acute brain injury rehabilitation facility with main offices in Bakersfield, seemed too far away from his family for treatment.
But Bonnie, 34, said the facility came highly recommended by their case manager at Santa Clara Valley Medical Center. The clinic made a good first impression on Bonnie and her mother. The equipment seemed high-tech and the staff friendly.
The Stows were sold.
Stow, 44, ultimately spent more than a year at the Bakersfield facility, receiving a barrage of therapies and living with other brain injury sufferers. The Stow family feels he made progress at the center, but his time there was unfortunately cut short. They said they had to bring him home in April because his health insurance would no longer cover the center's services.
"After a long two years of being away from home, the insurance company has ceased payment for CNS, so Bryan has come home. Let us clarify something very important -- Bryan could have benefited greatly by staying at CNS longer," the family posted on their blog.
The family is not naming the insurer per an attorney's advice. The Associated Press has reported that there is a pending lawsuit by Stow against the Dodgers organization and then-owner Frank McCourt, and that two Dodger fans are awaiting trial in Stow's beating.
Nicole Evans, spokeswoman for the California Association of Health Plans, said the trade group could not comment on Stow's situation, but wrote in an email Friday that health plans cover traumatic brain injuries based on the terms of their contracts and medical necessity.
"Medical necessity is established in consultation with physicians," she wrote. "Coverage determinations are very situational and determined on a case-by-case basis."
REHABILITATING IN BAKERSFIELD
Stow came to Bakersfield in March 2012 to live in an apartment complex with two roommates and receive constant care, Bonnie said.
His mother, Ann Stow, spent Monday through Thursday with him, while Bonnie and her sister, Erin Collins, took turns driving down to spend the weekend with him. The family stayed in an apartment.
Stow was surrounded by peers and he could see the different levels of injuries.
"He did really well there, he seemed to really like it," Bonnie said Thursday.
Stow had frequent speech, occupational and physical therapy, as well as recreational therapy every other week, Bonnie said. In September, his family wrote on their website that it was "really amazing to see his progress," but there were still "some steps backwards."
"Physically there are still his major hurdles, stiffness, pain, the extra bone growth that prevents him from doing simple tasks such as raising his arms. He is doing an amazing job maneuvering his manual wheelchair himself, even in tight spaces, but it takes him awhile to get where he is going and he gets tired," they wrote.
Stow was enjoying karaoke nights at his apartment complex, belting out "Eye of the Tiger" every time and later adding "Genie in a Bottle" to his repertoire. He was able to pack his lunch, make himself a peanut butter and jelly sandwich and play the card game Uno with his family and roommates.
"Sometimes he gets down or discouraged if he can't do something. We tell him that by working at it, he will be able to do it, and that is something we truly believe," the family wrote.
The Stows' parents got a wheelchair van and the family could go on their own outings, taking Stow grocery shopping on Saturdays and to the movies for the first time since his injury, Bonnie said.
Bonnie said Stow was eventually able to walk a bit, though he had to rest along the way: "He got to a point where he could use a walker and walk down hallways."
But earlier this year, blood clots landed him in local hospitals several times, according to Bonnie and the blog.
"Because the blood clots were very large and the location of them, he wasn't allowed to do what he was doing before" in therapy, Bonnie said.
In March, the Stows' website said Stow was hospitalized a third time and it meant "huge set-backs for him, both physically and mentally."
His family said he couldn't do as much and standing became painful because of a clot in his leg. Earlier this year, his case manager at the center began mentioning that his insurance might not pay for the center's care anymore, Bonnie said.
By the end of April, he was home at his parents' house in Capitola.
Mark J. Ashley, founder, president and CEO of the Centre for Neuro Skills, has said the out-of-pocket price for center services can reach $45,000 to $60,000 a month and patients must often end their stay because their insurance will no longer cover it.
Though his family had done what they could to ready for Stow's homecoming -- his parents' home was remodeled to be wheelchair-accessible and the family arranged caregivers to help Stow in the mornings and evenings -- Bonnie doesn't feel they were prepared enough.
"In the beginning we were fine. We were happy to be able to bring him home. We didn't know at that point that his insurance was going to be cutting his therapy as much," Bonnie said.
The family is still struggling to figure out how to get Stow the therapy they say he critically needs. Bonnie said Stow's insurance has alloted him 30 hours each of physical, occupational and speech therapy a year. He's been home about a month and a half but he only had three hours left of speech therapy, she said.
Stow has regressed since returning home, Bonnie said. It's becoming painful for him to stand up and transfer from his bed to a wheelchair and he has gained weight because he is less active, she said.
His mood has changed as well. He can't verbalize if something is bothering him so if his family asks what is wrong, he says he doesn't know, Bonnie said.
Bonnie wonders if Stow's mood could be dampened because he was very active before his injury and now is losing some of the ability he gained back post-injury, or because he is no longer with his peers.
"Sometimes he just kind of seems quiet, which makes us think he's feeling kind of down or depressed," she said.
Bonnie said Stow also has painful extra bone growth caused by his brain injury, which means he can't straighten out his arms or rotate his shoulders. He needs multiple surgeries and already had one on his hip for the issue, but he would have to be off blood thinners for further surgery, Bonnie said.
"I think the hardest part for all of us is thinking about how he may feel with us having to help him," Bonnie said. "The idea that I have to help my older brother shower, that's the hardest part of it, the emotional part of it."
On June 6, the family updated the blog to say Stow had returned home and to share the issues they are grappling with. They included an uplifting slide show of photos throughout Stow's recovery.
"We are so glad to have him home, but as prepared as we thought we were, it was a difficult transition. Bryan requires so much assistance and it is impossible for Ann and Dave (Stow's parents) to do it alone. Bryan requires 24-hour nursing care, but this is not covered by insurance," the family wrote.
The response to the post "was very heartwarming and humbling," Bonnie said. Support for the family swelled after Stow's injury and blossomed again with the family's most recent needs.
Bonnie said her family wants to buy equipment to use at home to supplement his lack of therapies. She said an ideal situation would be for Stow to stay at home but receive more therapy, about three hours a weekday.
"Obviously we're going to have to appeal to the insurance company because the fundraising money isn't going to last him forever," Bonnie said.
Despite the challenges, Bonnie said the perks of having Stow home are that family can be together again. Family dinners are back. Stow's 14-year-old son, Tyler, and 10-year-old daughter, Tabitha, can visit more often.
As the family faces new challenges, Bonnie said they appreciate the care Stow received in Bakersfield.
"From day one (the staff at The Centre for Neuro Skills) were so helpful and friendly and they made us feel as comfortable as possible."
Bonnie said she hopes that Stow gets the help he needs to progress to his full potential, whatever that may be.