Who Needs ASOs?
by Mark Scaramella, February 24, 2016
Last Tuesday the Board of Supervisors spent most of the day trying to deal with the highly anticipated Kemper report regarding Mendo’s disastrous privatization of mental health services.
The most frequently heard platitudes centered on “tensions” between various offices and organizations, and “lack of communications” between those offices and organizations. Everyone nodded as if these cliched vacuities were of clarifying value, and as if the County hadn't paid millions for these tensions and failures to communicate. At one point Supervisor McCowen observed that because nobody asked for competent reporting from the contractors, especially Mr. Ortner and Co., beneficiary of million dollar failures to communicate, “there was no effective way to resolve those tensions.”
The consultants pointed out that there is no enforcement mechanism for the few requirements there were in the present contract (which, as the consultants pointed out, excluded a number of routine contractual provisions, such as proper reporting). They also noted (as we pointed out months ago) that Ortner’s clients are routinely released from whatever locked residential care setting they were put in without an “aftercare plan.”
Asked by Supervisor McCowen how insurance coverage played a role in the handling of patients, the consultant with Mr. Kemper, a Dr. Featherstone, pointed out that it’s not so much whether patients get seen initially, but what happens to them after they are seen. Featherstone noted that lots of hospitals in Northern California — both medical and psychiatric — simply won’t take uninsured people. Period. So that means there’s frequently nowhere for uninsured patients to go after they leave the emergency room, even if they continue to suffer from a breakdown. And no aftercare plan. And no local residential facility. And no real outpatient follow-up. And no, and no… and no nothing, just back to the street to repeat the cycle.
Kemper recommended that since the Ortner deal is worth multi-millions betweem ($8 or $9 million annually) the County should have assigned a contract manager to make sure what little of substance there was in the contract was complied with. (This has to be pointed out? In Mendo, Yes — it does.)
The consultants recommended that the County set up a lessons learned process so that when mental patients are mishandled again — as they surely will be — there’s an opportunity to review what went wrong and correct the problem — especially since the same people are seen over and over again.
Board Chair Dan Gjerde complained that “your former director” (as Tom Pinizzotto was gently referred to throughout Tuesday’s proceedings) told him that some of the contract provisions recommended by the Kemper report would be added to the contracts but they never were. “I think I was lied to,” Gjerde bluntly declared. Consultant Kemper tried to soften Gjerde's harsh but accurate characterization by saying, “I think the former director meant to put those in but he didn’t.” Meant to? A contract worth annual millions? Pinizzotto was smart enough to know that he could flim flam Director Stacey Cryer and the Supes by just nodding his head, smiling and agreeing with them, then doing nothing — because there’s never any follow-up in Mendo on anything. Ever. Nobody puts together a formal “to do list” with dates and commitments which require performance or even an explanation of why commitments were not met and puts it on a slide with status. They just go on to the next self-created fiasco and do the same thing again.
Supervisor Dan Hamburg tried to downplay the mess described by the consultants by suggesting that the confusion stemmed from “rookie mistakes,” with “no ill motives.” “Was staff just overwhelmed?” Hamburg asked. The consultants, of course, agreed that, gosh, they tried real hard but.....
Hamburg went on to characterize a highly critical Ukiah Daily Journal editorial by KC Meadows as an allegation that the privatization exercise was “an abject failure.” In fact, Meadows wrote that the Kemper report “does not express the disappointment and outrage so many are feeling at the total failure of the county at the highest levels.” Which is close enough to what Meadows said and, if anything, an understatement.
However, Hamburg also complained that Editor Meadows had alleged that County staffers had “remained mum” even though they knew there were serious problems with the mental health privatization. In fact, Meadows simply said, “There are people still in the hierarchy at the Health and Human Services Agency who did nothing as the problems with Ortner became clear from almost the outset.”
Meadows is obviously correct in saying that County staff “did nothing” because they in fact did nothing. Not only did they do nothing, they consciously defended the mess and pretended there was nothing wrong.
And now those same County staff (minus Pinizzotto) who created the problem are probably going to be asked to implement the Kemper recommendations. The same people who defended Ortner and the privatization mess for over two years now in the face, even, of mounting complaints from the Sheriff and dozens of local physicians, are now going to be tasked with doing what the Kemper report calls for? If you believe that, you qualify for mental health services from Ortner — if you’re insured.
At the end of the meeting, after a number of critically pertinent comments from members of the public and the Supervisors, the Board decided to direct staff to both work with the two contractors to improve the contracts along the lines suggested by consultants Kemper and Featherstone, and at the same time (i.e., in the next few months) work on preparing a new Request For Proposal (rfp) if or when the Board decides to dump Ortner, which they all seemed willing to do tomorrow if dumping the Yuba City hustler weren't so disruptive. All in all, it was a better than average Supes meeting, with the public and staff dealing addressing the real problems with the County's privatization of mental health services.
Too bad it took the Supervisors three years to do it (going back to the initial days when the RFP was prepared).
If it were up to us, we’d eliminate the entirely redundant “Administrative Service Organizations” (an idea that was sold to the County by Tom Pinizzotto just to line the pockets of Ortner) which do little more than contract out to subcontractors and charge the County for an unnecessary administrative service that existing County staff can do. In other words, reduce the privatizations to selected local first-line service providers and professional medical billing services, which is where the County was having problems in the first place. As it is, Ortner is just soaking up big chunks of administration bucks for a service that need not and should not be privatized.