Mental Health In A Pickle
by Mark Scaramella, March 30, 2016
Doug Gherkin is “Chief Financial Officer” for Mendo’s Health and Human Services Agency. Until recently, before Stacey Cryer announced her resignation as HHSA Director, Ms. Cryer dealt with Supervisors’ questions about HHSA finances — albeit with a heavy dose of obfuscation, buzzwords and ill-defined terms that carefully avoided committing her Department to anything. The Supervisors, usually just as obliviously imprecise as Ms. Cryer, typically asked questions as vague as Ms. Cryer's inevitably bafflegabbed answers.
At this point it’s necessary to repeat our nearly monthly call for regular departmental reporting. As we’ve suggested time and time again, the Supervisor could easily avoid much confusion by simply requiring each department to provide a monthly status report on staffing, budgets, projects, cost drivers and problems — i.e., actually operate and manage the County like every other large organization in the civilized world is managed. But they don’t. So things always muddle along and nobody’s accountable for anything, and the Board is often surprised by mattersthey should have been tracking all along.
Anyway, back to the pickle Doug Gherkin found himself in a couple of weeks ago.
During the Supe's March 14th budget review, Supervisors John McCowen and Dan Gjerde tried to clarify the Mental Health budget numbers. And Gjerde asked how many employees toil in the Mental Health Department.
Alan ‘The Kid’ Flora, Mendo’s budget maven, didn’t know so he suggested “someone from the agency” answer that question. Since there was no Ms. Cryer, up came Doug Gherkin.
Gherkin: “We had so many changes. Unlike the general fund, our general fund budget units, we get — we start our budget process in April, but we don't get our information until after July, so we always have to make adjustments. In order to, in order to do the detail you guys need to make your decisions and to stay with the CEOs push for transparency, we put it all out there. We are — we are going to work with the CEO's office to bring — to bring down the level of details so we don't drive you guys crazy with details — yet give you the information you need. So that's what a cut — so that's what makes out all these adjustments. Any more questions?”
McCowen: “I will accept the answer. [Everybody laughed nervously at McCowen’s acceptance of Gherkin’s obviously non-responsive reply.] ... "If I am understanding it correctly," McCowen said, "within mental health the total outlay is about $27.3 million.”
Gherkin: “No, that's still not $27.3 million. I don't see where you are seeing that.”
McCowen: “The $20.6 million, plus the $6.6 million?”
Gherkin: “Are you adding budget unit 451 into that?”
McCowen: “I'm adding the revenue estimate and then the $6.6 million that's shown at the bottom. I — you know, correct me — I'm sure I'm wrong. But I'm willing to be wrong. What's the total cost counting revenue that we receive from other sources and our required maintenance of effort?”
Gherkin: “The way the sheet works out, that is a little misleading. There's no way, I assure you, no mental health budget unit is going to go over $20 million.”
McCowen: “So I'm asking, what is the total mental health budget, all revenue sources including net county costs combined?”
Gherkin: “Well, there's no net county cost in there, so I'm going to say it's at $20 million.” (Turns around and looks to people behind him as if some magic numbers person in the dim recesses of the Supe's chambers might help him out.)
Thereupon commenced a rambling, multi-party math quiz as the Supervisors and the Gherkin team tried to puzzle out exactly how much money was contained in the Mental Health budget.
Gherkin, apparently hopelessly stumped, said he was turning to his bullpen. “For that I am going to bring my pro up for that, she's got the stuff, Mary Alice, from HHSA, so I will defer to her.”
Flora continued the number quiz: “Total appropriations that are in the adopted budget is $4.8 million.”
McCowen: “I was actually fairly close on that one. And if you add the two together than we do get $27 million?
Mary Alice Willeford, HHSA staff: “You're asking… Could you repeat the question please?”
McCowen: “The total expenditures under the mental health services act portion of the budget — Assistant CEO Flora says it's about $4.8 million.”
McCowen: “Thank you.”
After that rare moment of fleeting clarity, Gjerde vainly pursued the mystery of how many people were employed doing the number crunching and, we assume, doing something of value for people in need.
Gjerde: “So that's ten authorized positions?”
Gherkin: “That's ten of them. Ten or something. And the other kids — the other — kids! Sorry. The other employees in the system, there is still work that the county has to do even though if we contract out as much as possible, the accountability and oversight stays with the county so there will be some auditing, some auditing positions, some accounting positions that will stay in the mental health department and also too, to run bills and get the billing in and things, that still has to be vetted before we can send and pass the bills in to the state.”
Gjerde: “So roughly how many positions is that?”
Gherkin: “Eight or nine.”
Gjerde: “Eight or nine?”
Gherkin: “Not counting the director, the mental health director and the staff that goes with her, or him, I'm talking about just the pure accounting staff, there's probably about eight of them left, down from I think 12 or 13 back in the day.”
Gjerde: “So that's eight or nine, plus the ten in Katie A, so that's—?”
Gherkin: “And then a director. And her support staff.”
Gjerde, frantically trying to keep up with the numbers, “So that's 19 and then three more people? Maybe 22?”
Gherkin: “Right in there, yes.”
Gjerde: “So how — But I've been told we have 43 authorized? So how do we go from 22 or 23 to 43?”
Gherkin: “We might have 43 authorized but I don't think we have 43 employment.”
Gjerde: “Yes. So that is what I'm saying. If we don't have 43 and we have 43 authorized, but we only really employ 22 or 23 people; why do we still have another 20 positions on the books?
Gherkin: “We could remove those. Definitely. We want to have a little cushion there because again we want to make sure we offer accountability and oversight which the county is supposed to be doing but after that, yes, those could go because I don't expect to fill them back.”
Gjerde, at last addressing where the Mental Health rubber meets the actual services road: “Not to get too deep into it but doing prescriptions and giving shots to people who have schizophrenia or whatever, I met with a parent on the Coast recently and her son gets shots and she has had real difficulty because of Ortner's contractor providing the shots and not always showing up on the Coast and these are people who cannot get to an appointment on their own and so when you only have one day out of the week, maybe every two weeks, where this person is supposed to show up from Ukiah, it's a big inconvenience when that person from Ukiah doesn't show up in Fort Bragg. So one thing I think should be looked at is maybe a different model. Maybe the clinics. We have five of them throughout the county. Maybe the clinics are the ones who should provide the shots. They are open mostly I think five days a week, they give shots to people for other things. Maybe they can take up that task and be more customer friendly to the people who need the service.”
None of the questions the Supervisors asked were written down for future reply (other than here, and we will be watching). None of the questions any of them asked will be answered. Woodhouse will never get a breakdown of the hours of the "quality assurance" staff. Nobody will contact the local clinics to see if they can become part of the service delivery (because if they could it would have been done years ago). No one asked where the extra money (however much it turns out to be) for the transition and overlap of service will come from.
Notice also that when answers were ridiculous, nobody ever gets upset, instead they all giggle at how stupid or ill-informed the responsible party is. Even though regular departmental reporting — especially for mental health — is obviously essential to any kind of management of that service, no one even thought to ask — except when Woodhouse said, "I want that" in reference to a report on staffing, it will never be provided.
PS. The next day, the Board spent more time talking about the transition from Ortner to Redwood Community Services. And staff simply assured the Board that RCS will take care of everything, except for the things it won't. And the subject which again requires close management during yet another critical period that will remain off the radar screen of the Board until the next surprise or crisis, since they still have not asked for regular reporting on this or anything else.
In short: Another day of self-congratulatory blather about an important subject with minimal management or follow-up.
PPS. And Gherkin’s reference to “accountability and oversight,” is the biggest laugher: that’s exactly what the Kemper Report said wasn’t happening because Ortner wasn’t reporting and nobody was asking for reporting.