Mendo’s Mental Health Blues

At the Board Of Supervisors meeting on September 8th, Mental Health Board member Nancy Sutherland asked for clarification of the County's plans to put the current mental health contracts out for bid again although the current contracts have options for consecutive years through 2019.

Sutherland: I have submitted some questions. I understand I'm going to get some responses. I have one question that came up from Ms. Cryer's [Stacey Cryer, Director of Health and Human Services] report. I think on the OMG ASO [Ortner Management Group Administrative Service Organization, current adult mental health services contractor] contract that you are going to revise the scope of work and put it out for bid. I would just like a little bit of explanation about the changes to the scope of work and why. What's missing? What needs to be changed? Also I would like a copy of the Mental Health Board meeting and Stacey's notes if that's possible.

Cryer: I don't have a written report.

Sutherland: Oh, okay. I guess that's not my request then. (Laughs.)

Board Chair Carre Brown: Yes it is, because if you go get the recording —

Sutherland: When is the recording available?

Brown: Ummm — (long pause).

CEO Carmel Angelo: I'm sorry. I didn't realize I had to push the button. (Laughs.)

Brown: Is it red or not?

Angelo: We could have a recording of this section that's part of the meeting within a couple of days. We are still meeting today and tomorrow so probably by Friday we could have this portion for you.

Sutherland: That would be great. I was really glad to hear the good news about the audit exceptions. Thank you.

Angelo: That will be on there. That will not be a video, it will be the audio transcript.

Brown: But that will work for you, won't it?

Sutherland: Could I get an explanation about the scope of work?

Brown: I don't know if they are that far along. But if Ms. Cryer wants to respond, please do so.

Cryer: Thank you. What I said was that the — we have two ASO contracts. They have very similar contracts with very minute differences between them. What I said was we would be asking the Board to participate, two Board of Supervisors to participate, and we will be working on revising those scopes and those plans to put both of those back out to bid. So the mental health service delivery portion will go back out to bid and I don't have the scope revised. I don't have anything to say there, and I don't have a timeline yet. But we would like to move forward. As it is stated right now, the current contract ends after all the extensions June 30 of 2019. So we will have to work out all of the timeframes and we want to get started on that project and really work with the board.

Sutherland: So that's when they will go out to bid, in 2019?

Cryer: (Shakes head.) No.

Supervisor Dan Hamburg: No, they are renewable each year. Right?

Cryer: Yes. Correct.

Hamburg: So we could actually be working with new ASOs if we decide not to stick with the ones now as soon as next fiscal year.

Cryer: That's correct.

Sutherland: I'm still not clear. Are these bids for new ASOs?

Hamburg: They could be.

Sutherland: They could be.

Hamburg: Or maybe not. But we are going to go out to bid.

Sutherland: Okay.

Brown: It's all a question.

Okay, thank you.

* * *

Nobody answered Ms. Sutherland's question about "why" the County has decided to re-bid the Mental Health contracts. Speculation has it that at least two and maybe more Supervisors have been pushing for putting the Ortner and Redwood Quality Management contracts out for bid.

Supervisors John McCowen and Dan Gjerde have both made remarks about the cost and scope of work with Ortner's present contract. (Ortner's administration costs and case management costs are suspiciously high.) Supervisor Tom Woodhouse also seems to be mildly skeptical about the existing contracts, and Supervisors Hamburg and Brown, based on the above exchange, are clearly in agreement that the contracts should go out to bid again.

We assume that the County thinks they can get a lower bid for the contracts by reviewing the scope of the work Ortner is allegedly doing.

According to the Grand Jury, the only bidder in 2012 besides Ortner and Redwood Quality Management was a national health service organization called Optum. County staff reviewed the bids and rated Optum's bid much lower than Ortner or Redwood Quality Management, but no information about the cost or rates of the bids has been released.

Guess why the more expensive Ortner bid was the one the County adopted?

The Grand Jury pointed out that it appeared that then-County Mental Health Director and former Ortner executive Tom Pinizzotto exerted undue influence on the contract selection process.

The County later denied saying that although there was an "appearance" of a conflict of interest, there was nothing illegal and no "actual" conflict of interest — even though an "appearance" of a conflict is a conflict. The Grand Jury also found that "County guidelines are insufficient to address perceptions of undue influence." The totally tone-deaf County response said, in effect, that because Mr. Pinizzotto was not currently working for Ortner there was no conflict!

Pinizzotto, however, had just arrived in Mendocino County from Ortner. Worked for Ortner at Ortner's Fairfield operation. That facility was closed and Mr. P became a consultant for, guess who? Mendocino County. So impressed with Mr. P's consulting, Mr. P was then hired by HHSA from where he steered the privatized deal, worth between $7 and $8 million a year, to his former employer, Ortner Management Group. The guy was "consulting" for Ortner while Mendo was preparing the request for proposals for privatization — translation: Telling Ortner how to shape his bid.

Pinizzotto is now Assistant Director of Health and Human Services for Mendocino County. Will he have any role in deciding whether Ortner continues with the Mental Health Contract? So far, nobody has said anything about excluding him.

Toward the end of the Tuesday, September 8th, Supervisor's meeting, both Supervisor McCowen and Supervisor Hamburg went out of their way to complain about the "adversarial" tone of the Grand Jury report concerning failures and understaffing in Family and Children's Services, adding that they "think" FCS is doing an "excellent job under the circumstances" (i.e., not enough money — none of these people ever have enough money in their opinion). McCowen said the Grand Jury puts in too much stuff that has to be "filtered out" to get to the point. Hamburg added that the Grand Jury reports are "really one-sided and unfair," which create a negative impression of a well-run office.

So which is it? Is the Grand Jury out of line? Or are the Supervisors the final arbiters of the "excellence" of their half-privatized department?

Answer: The Grand Jury goes to a lot of trouble investigating the particulars of whatever subject they've taken on. The Supervisors get no regular reports from departments and so must take the word of the department head who probably isn't inclined to reporting problems of their own making. (Although they're certainly willing to talk about funding shortages.) The Board has never had any trouble "filtering out" the Grand Jury's remarks — to the point that they usually just have County Counsel write "The Board of Supervisors disagrees with this finding."

What Mccowen and Hamburg are really saying is, We don't want any dirty laundry aired in public because we don't want to look bad. But they are supposed to be supervising Mendo's public agencies and, in this case, they got hustled big time by Pinizzotto and Ortner.

The Grand Jury is the public's representative. There is no other outside watchdog vehicle available to taxpayers short of the DA and, of course, the media. The Grand Jury generally goes out of its way to applaud well-functioning public agencies and strains to avoid naming names. The Supervisors should be much less defensive and take the Grand Jury reports in stride, not whine about the "tone" of Grand Jury reports.

(We think the DA ought to be looking at the Ortner privatization deal.)

The Grand Jury Report under discussion was their recent report critical of Family and Children's Services. One example of the "tone" the Board was probably talking about was this from the Report summary: "In spite of a dedicated, caring, hard-working staff, the agency appears to be falling further behind. Every performance indicator points to understaffing as the main culprit. The understaffing has many causes: non-competitive compensation, work overload, poor management, and low morale. Senior management is aware of the issues and their consequences but has failed to address them. A number of the interviewees expressed grave concern that because of the current state of affairs in Family and Children Services Agency, 'a disaster is waiting to happen'."

Ms. Cryer told the Board that they were doing everything they could to recruit and retain people. The Board is trying to set up a retention bonus system for social workers and public health nurses which, like experienced cops, have been hard hang on to. But the Board seems unable to comprehend that there might be shortcomings in the management of the department. Since there's no regular departmental reporting, they must take the word of the aggrieved department head that all's well and the Grand Jury is overly critical. The "adversarial tone" has more to do with the Board not getting regular reports from its department heads than it does with the criticisms in the Grand Jury reports. Supervisors always seem shocked when even minor fault is found in the operations of their departments. But without decent departmental reports, the Board has no ability to determine the validity of the Grand Jury reports so nothing much improves.

My late uncle, former Fifth District Supervisor Joe Scaramella drafted the first set of Board rules and created Mendo's Civil Service Commission and its rules, just to name a couple of relevant examples, after having complained about the County’s insider hiring processes for years before finally getting elected. He liked to quip, "Criticism is essential. If nobody says anything negative, how can you expect things to improve?"