Waiting For Ortner
by Mark Scaramella, May 25, 2016
The great transition from one privatized mental health entity to another private mental health entity is just over a month away and nobody knows how many clients there are or what kind of back-up paperwork the Yuba City privateer will produce. He made millions off Mendocino County but what exactly did he provide and where did all the money go?
Mendocino County’s new mental health director, Janine Miller, told the Supervisors on Tuesday that the County still has a lot of vacancies in her department, most of them unfilled for months.
Ms. Miller, who has inherited a true quagmire and we hope she's not being set up as a scapegoat for disasters to come, disasters she did not set in motion, said there are about 40 employees in her department but 57 authorized positions, leaving 17 vacant. Miller and several senior members of her staff are covering multiple positions to partially make up for the vacancies, but it’s not easy, she said. And since there's no way of corroborating bureaucratic assertions like this I suppose we have to take her word for it.
Third District Supervisor Tom Woodhouse agreed, sort of.
“A good example of a vacant position — it's been vacant for awhile; it's been vacant for whole time I've been here and it has been vacant for at least two years or three years or — is the County Psychiatrist. We are offering I think around $300,000 a year for that position and it needs to be a minimum of $400,000 to attract anyone. We might as well take it off the chart. We are never going to get that person here. And that's where we would be paid back by the feds and the state and it's nonsense to have that position listed here. I'm not saying that to you, I am saying that to myself: Why do I allow that? That's ridiculous. It's pretending you're going to paint the house and you don't have any paint and you are never going to do it. We need that position filled. Without that we can't do a damn thing. So why can't we start with that? I guess I'm asking the CEO in our next budget round to put that position at $400,000 and if somebody files a grievance, let them. Sorry about that.”
CEO Carmel Angelo: “If the full board wants to pay $400,000, I will put it in. No problem.”
Board Chair Dan Gjerde, as always attentive and on task: “But the question is, Is there money to do that? I guess the question I have also is my understanding is that the Sheriff's office also has a position of a psychiatrist and they are also unable to hire them but they have a doctor in the box, like someone doing tele-psychiatry.”
Angelo: “There's no county position for a psychiatrist [at the jail]. That would be contracted. I'm assuming that's contracted to CFMG [the jail medical service].”
Gjerde: “So they are unable to fill the position and they have someone on a monitor coming through a television screen. So why not take the two positions and combine them into one and have a real live body here?”
Angelo: “Certainly we can look at that. One is a contract position and one is a county position. I think we have to look at how we would do that.”
Deputy CEO Alan ‘The Kid’ Flora, a capable young dude whose contributions to the public discussion are unfailingly pertinent: “Mental health is not one of those programs that you can direct bill any amount of cost that you want back from the state and the federal agencies. If the salaries are increased for example, my understanding is that generally speaking 60% of that cost has to be paid from our revenue sources that we get, primarily realignment revenue which are based on sales tax receipts at the state level. So that is a limited supply of funds. You can't just increase that at will.”
Woodhouse then tossed a word salad which, listening very, very carefully seemed to arrive at an assertion, albeit a self-contradictory one:
“We have the tele-psychiatry in Laytonville. We are going to work with the clinic and it will take time to get it together but they are going to do it. I'm going to bring that to the board. But the people in my district are killing themselves. We have to get a psychiatrist here. If you have a tele-psychiatrist, they can look at somebody and prescribe medications and save their life and stabilize them while in crisis. That's the whole purpose of what we are trying to serve here. So I'm not angry, I'm just determined that we are going to do this. Every time I ask the question I always get the response of why we cannot do it. And I agree. It's impossible. We can never do it. Now how can we proceed ahead and do it? I don't care which one of these things we do. But we have to start changing things. Proceeding like we are now is going to lead to failure and I refuse to sit here for two more years and do that. We are going to change this. I'm proud that you are here. I'm excited you are here. I'm glad that you are here. I am asking for help and how to go forward.”
Hmmmm. I'd say on balance that Woodhouse wants a shrink for his constituents even if it's a doc in a box like they have at the jail. But I’m just guessing.
Predictably, none of Woodhouse’s colleagues picked up on any of this, and none of them expressed any interest in putting up $400k for the vacant County psychiatrist position.
* * *
Later in the meeting, during a discussion of how the County was going to use some $500k in Mental Health Housing grant funds that have gone unspent for a couple of years or so, Chair Gjerde asked Rural Communities Housing Development Corp. executive director Tim Pallesen how he was going to proceed to find a location for a mental health housing facility with perhaps 30 or 40 beds in one of the three incorporated cities in Mendocino County.
Let's hold it right there. Let's all get behind the Sheriff's plan, all pull at the same oar at the same time. He has the first sensible, doable, much less expensive, much more practical idea ever broached in modern Mendocino County. Boiled down? Our own mental health facility, where, we would hope, the mentally ill now housed at the un-therapeutic County Jail, would he held and, perhaps, even made functional again. We would also hope that the free range, drop-fall drunks and thanatoid-type dope heads who make up the bulk of the "homeless" would also be confined because, objectively considered, they're also crazy. Staff? The mental health people presently wandering around with coffee cups doing zero of practical value for the mentally ill.
Pallesen suggested that the county contact the city councils in the three cities and “ask them to confirm or deny that they would support any project that would be in their cities. We would then come back in and report to this board the results of that communication.”
Pallesen! Dude! Listen up! Get behind the Sheriff's plan. The cities aren't going to go for anything inside their city limits unless the Sheriff and their police chiefs get behind it. Everyone, including you, ought to looking long and hard at the old Willits hospital for a centralized facility with services concentrated there, not all over hell and vaguer than hell like they are now, with the cops doing ALL the mental health heavy lifting.
Gjerde: “I think their support or lack of support would definitely have to do with the location. There needs to be some idea of where. (The Willits hospital, Dan. Get on board!) They might support it if it was here, but not there. Within their city, or near the city. If it is just a blanket statement, that is not enough information to say whether they support it or not.”
Pallesen: “Would you like a formal statement from the various city councils in the form of resolution?” (Which is highly unlikely you could ever get.)
Gjerde: “I think they need to have some idea where in the city you are thinking. There needs to be some initial research to identify three or four possible locations and if it was any one of these locations, would you support it and if so which ones?”
Pallesen: “Unfortunately, there is a real estate availability issue that is pretty transitory. So any time a city council would say this is a good spot here, it might take us at least three months before we can even make an offer on it, and then the price might go up and also it might disappear from the market.” (Jezus H, Pallesen! We can get the old Willits hospital for less than $2 mil. Focus, man, focus!)
Gjerde: “But I think you're asking too much of someone to say ‘anywhere,’ is it okay? It's not realistic to request that, to ask for a blanket ‘anywhere’ approval.” [Laughs.]
Pallesen: “Okay, yes we certainly would be working with the city in getting that kind of input from them, for sure.” (Translation: Endless meetings, endless donuts, endless confusion.)
Gjerde: “Not to criticize anyone here, but it's unfortunate that the county has held this grant for a couple of years now and it's unfortunate that it's taken this much time because we knew it would take more time to do site identification and more time for the cities or the county to identify Community Development Block Grant funding and other funds to provide the match. The chart you have concerning the example from Arcata is very enlightening because it shows they had about $870,000 to match in loans or grants that the city obviously had the time to cobble together. With such a short time frame here at this point to make decisions and accumulate matching funds—” (We're spending twenty MILLION every year right now for what? Nada. Nothing. Christ on a gd crutch. Shake yourselves. Do the goddam math. 100 crazy people, maybe 200 if you factor in the career drunks and free range tweekers. Divide 200 into twenty mil. You can't come up with a viable plan?)
Pallesen: “I don't think it's there. It would be great if it happened. But I don't think it's reasonable to expect any of the three cities to come up with money.” (They don't have it because they pay their governments so much there's hardly anything left to do what needs doing. But the County has twenty annual mil! More if the Sheriff's plan is approved by the voters.)
Gjerde: “But they could have had a headstart on this process two or three years ago — they could have.”
Pallesen: “That's possible.”
Gjerde: “Anybody can apply for community development block grants every single year. And they probably have, both in Fort Bragg and here in Ukiah — for two or three years now. And now here we are three years later trying to scramble and put something together.”
Pallesen is supposed to begin looking for sites in Willits first (apparently because it’s midway between Fort Bragg and Ukiah), then Fort Bragg and then Ukiah. (Here we go. The site search. Hello, Happy Donuts? Can you bake us three years worth?)
* * *
The ambitious Transition Plan which lists the tasks necessary to turn the for-profit Ortner (Yuba City) adult mental health clients and services over to the for-profit Redwood Quality Management Service (Ukiah) continues to show that most tasks remain conspicuously incomplete. A few more meetings have been held and various agencies and companies "continue" to do various amorphous things, but that's about it.
One recent update reports that “RQMC has developed a general plan for handling application assessment, assigning care managers, documentation and reporting. This includes planning for client centered flex funds to be used for non-Medi-Cal client needs.” There it is, folks. The crux. How do we get paid for the people who don't have insurance, formerly known as a public responsibility.) But the “plan” is not in writing and it doesn't say anything about anything actually being completed. (Because none of the people involved in the transfer are what you would call "clear thinking.")
Another task involving development of a replacement outpatient provider service shows that the only new development is that “Ford Street has decided not to provide mental health services through Medi-Cal at this time although they will continue with their clients to provide drug alcohol treatment.” (Because there's lots of public money for that and it's your basic growth industry as more and more citizens grow ever more despairing.)
Everything else on the transition plan task list is either “continuing,” holding more meetings, or “in process.” (Everyone involved ought to be locked in a donut-free room until they get it done.)
The County’s high-paid mental health consultant and smooth talking jive-o, Lee Kemper, who prepared the report last February documenting many of the problems with Ortner and precipitating the challenging transition that Ms. Miller is trying to arrange, told the board that it’s now been over two months, and it wasn't even clear how many clients Ortner had, much less what kind of documentation they have on each one. Kemper said that he’s heard that Ortner had somewhere between 200-500 clients and that the county has still not received any documentation concerning these clients. (Because the County has been ripped off, big time, a fact documented in these very pages for more years now.)
But Ortner collected millions with almost no accounting for the money.
Mental Health Director Miller said that Ortner had been rhetorically cooperative so far, having agreed to deliver the records, but nothing has been supplied. (Can we say “scam”?) Apparently Ortner plans to scan in their documentation and put the entire document collection on a flash drive and deliver it to the County in one giant submission sometime in June. But nobody knows what it will look like or how compatible the data will be with the “Avatar” electronic health records patient management system the county hopes to use with their new contractor Redwood Quality Management Company (RQMC). (Can we say “criminal” mis- and malfeasance?)
Given Ortner’s wildly overpriced and undelivered "services" on just about everything else over the prior three years, we suspect his "records" will be incomplete and indecipherable.
Ms. Miller — and she has our total sympathy and best wishes as the blindfold is placed around her eyes and she's lead to the firing squad — insists that things are moving along as best they can toward the July 1 date when Ortner will go away and Redwood Quality Management will magically pick up the pieces. But as consultant Kemper said, it is unknown what the extent and quality of Ortner’s records will be. Kemper pointed out the obvious: the sooner they can be submitted the better. (Gee, thanks, Mr. Consultant. You can go now.)
Of course, waiting until the last minute like this for the Ortner documentation — the Mendo equivalent of Waiting For Godot — means that any problems with information — gaps, errors, questions, misidentification, confusion, contradictions, etc. — won’t show up until Ortner is gone and unavailable to answer questions — unless the price is right.
Somehow the County’s understaffed mental health department will have to figure out a way to prioritize the Ortner stuff — and the who-knows-how-many mentally ill clients themselves — so that the ones in the most urgent need will get the earliest service.
How all that will be done given the short staffing and the growing list of incomplete, in-process tasks, remains an open question whose answer lies inside a giant jelly donut.