At 9:06 a.m. Mendocino County Board of Supervisors Chair Carre Brown gaveled the Tuesday, December 15th meeting to order then opened the speaker's podium to comments from the public on non-agenda items. Dr. Marvin Trotter, once the county's public health officer and now a physician at Ukiah Valley Medical Center stepped forward to introduce a counterpart at Howard Memorial Hospital, Dr. Ace Barash. Barash read a two page document reproduced as closely as possible here:
“I speak on behalf of Mendocino County physicians and health professionals in addressing the current system of providing mental health care. The overall feeling is one of frustration and disappointment having to do with availability of services and lack of integration by the current provider, Ortner Management Group. The areas of insufficiency concern outpatient services, hospital relations, and the types of services currently emphasized.
“When asked regarding the overall quality of mental health care, a frequent response is that it is 'a little bit better' than it used to be before the engagement of the current provider about two and a half years ago. I think that this is true when it comes to promptness of mental health facility treatment for those determined to be a danger to self or others. In fact, this was one of the initial objectives in engaging Ortner Management Group at the outset and this they do reasonably well due to their owning and maintaining facilities in other counties in which patients may be treated. The problems stem from their overall concentration on this class of patients and the fact that, with our progressively increasing lack of infrastructure, we have negligible means of stabilizing patients before they arrive at such an intensity.
“The availability of local mental health services for the patients of our county has deteriorated markedly, outpatient and day treatment, respite care, and necessary local programs. This is definitely not better than previously. Studies have shown that patients treated earlier may be prevented from arriving at the level of dangerous intensity, ie. 51/50 by 97%, that is only three percent of those dealt with early progress to 'danger to self and others.' This has been widely recognized in recommended provision of best practices.
“Further, our mental health services are being provided by an outside contractor, who cannot be expected to have the same degree of concern about our local patients and personnel as those who have lived for many years locally. There has been friction and disagreement between the managing group and our own facilities that seem to highlight their status as 'outsider.' This has escalated to a level of a lack of trust and confidence in providing mental health services. This is a very serious aspect in deterioration of our local mental health services, the lack of collegiality and collaboration between OMG and our own providers.
“Availability of talent and heart abounds in local residents who might potentially be providing Mendocino County mental health care; we have a lot of available resources. These are, unfortunately, beginning to atrophy, due to the palpable lack of inspiration which currently predominates the mood of services.
“The problems that we have had in years past, in fact are currently surmountable with adequate planning and wider participation. Certainly, it would be necessary to build adequate oversight into such a system, through a contract that provides for checks and balances. Possibly this would be accomplished by allowing the mental health board more power and actual participation in administering the provision of services. Alternatively, a committee could be formed composed of county doctors and a fiscal officer that would report to the board every quarter. They should be aware of all of the details regarding budget activities and given the power to approve or disapprove from an informed standpoint. Any provider of services must be bound by a contract that holds them accountable and an agency that oversees their activity.
“We health care providers of Mendocino County feel that it is still within our reach to develop a mental health care system of which we can be proud that would also be within reach of our budget. However if we continue on the current trajectory, we don’t believe this can ever be achieved.”
The “we health care providers” Dr. Barash alluded to showed up on an attached list provided to the Board of Supervisors. More than fifty doctors, nurses, nurse practitioners, physicians assistants, and psychiatrists from around Mendocino County apparently signed on to the statement read by Dr. Barash. They are: Dawn Magdelin-Betts, MD; Jeremiah Dawson, MD; Judy Lemke, FNP; Anne Robinson, ACNP; Irene Forrest, NP-BC; Valerie Takes, ACNP-BC; William Bowen, MD; D. Mills Matheson, MD; Angus Matheson, MD; Elizabeth Whipkey-Olsen, DO; Candice Dolbier, DO; Carla Longchamp, MD; Tedd Dawson, MD; Brenda Begley, DO; Betty Lacy, MD; Rebecca Timme, DO; David Ploss, MD; John Glyer, MD; Kim Faucher, MD; Rick Bockmann; Mark Luoto, MD; Gary Fausome, MD; Anne Retallic, FNP; Robert Pollard, MD; Ace Barash, MD; Alejandro Casillas, MD; Monte Lieberfarb, MD; Michael Medvin, MD; Bruce Andich, MD; Samuel Martissius, MD; Lynn Meadows, PA; Mary Newkirk, MD; Leslee Devies, DO; Gary DeCrona, MD; Lynn Coen, MD; Mim Doohan, MD; Harry Matossian, MD; Cotti Morrison, FNP; Suzanne Hiramatsu, MD; Roger Cheitlin, MD; Jorge Allende, MD; Walter Bortz, MD; Charles Evans, MD; Marvin Trotter, MD; Terrence Tisman; Kari Paoli; Keilah Miller; Andrea McCullough, MD; Tambra Baker; Peggy O'Reilly, MD; Steven Dagenais; Brendon Smith; Eli Weaver; Megan Collison; Robin Serrahn, MD; Tamaki Kimbro, MD; Aaron Stauffer, Tammie Bain; and Helen Remey, RN.
The number of health care professionals signing on to an open and public questioning of the privatized provider of adult mental health care services in Mendocino County speaks for itself. Dr. Barash was briefly followed to the podium by Sonya Nesch, a local board member for the National Alliance on Mental Illness (NAMI). Ms. Nesch presented the supervisors with a one page chart detailing the increase in emergency room (ER) 5150s (involuntary psychiatric holds) over the past five years which she attributes to a decline in mental health services. Since Ortner Management Group has taken over mental health services for those 25 years of age and older, 5150s have increased from 145 throughout the county in 2013 to more than 400 in 2015.
Next up to the podium was Mendocino County Sheriff Tom Allman, who stated that he was speaking on behalf of three chiefs (presumably the police chiefs of Ukiah, Willits, and Fort Bragg) and himself. Allman didn't mention Ortner by name, but he did say that one of the privatized contractors of mental health services has fewer complaints against it (presumably Redwood Children's Services). He stated what has become obvious to anyone paying attention in recent years, law enforcement has become preoccupied with responses to mental health care calls. In other words, mental health is the number one public health safety concern in this county.
The Sheriff's most verbally forceful point came when he insisted that Mendocino County needed its own mental health facility, seemingly a jab at Ortner placing Mendocino County mental health clients in its facilities in Yuba City. When Allman was done 4th District Supervisor Tom Woodhouse asked for the issue to be placed on the agenda for the Board of Supervisors' next meeting January 5, 2016. Supervisor McCowen pointed out that the Supervisors were already scheduled to hear the report of Kemper Consulting Group regarding the county's mental health system on that date, so, in effect, the issue was already on the Jan. 5th agenda.
One of the reasons speakers like Dr. Barash appeared on December 15th was to “get out in front” of the Kemper report, which, in the quarters of those who signed on with Dr. Barash's remarks, is suspected to be something of a “whitewash” of Ortner Management Group's ability to capably run county wide adult mental health services.
Trotter, Barash, Sheriff Allman’s and all the other medical staffers confirm what everyone here has been saying since a good part of the County's mental health services were privatized. It's not working. Where it used to take County mental health workers hours to evaluate 5150s at the various emergency rooms, thus making the cops wait around until the workers showed up, Ortner's workers — Ortner's the guy the County gave our mental health system to, gifting him upwards of $8 mil a year — show up fast to simply say, “This guy's ok. Soon as you get him down off the ceiling, he's good to go.” Or, more likely, they say, “Take him to jail. We don't want him.” Ortner, natch, as a businessman, keeps services to a minimum to make as much money as he can off defenseless people. If the Supervisors were capable of shame, they might be. Shamed, that is.
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DR. MARVIN TROTTER: “As an inpatient and emergency room physician as well as the chief medical officer at Ukiah Valley Medical Center and an ex-public health officer I have had broad experience with the mental health issues facing this county. I have attended many meetings over the years. Three years ago you had a department that was in disarray that I felt lacked professional qualified managers. To improve the situation the department was privatized to Ortner Management Group but the prior managers were retained. Unfortunately over the last two or three years I do not think this has been a successful solution. The solution to coronary artery disease is not more bypass surgery, but control of diabetes, hypertension and follow-up attention from primary care providers. The solution to mental health disorders is not more 5150 admissions but professional outpatient therapy, medication, case management and housing. These are the upstream issues that need to be addressed by the county within your budget. I urge you to have a series of meetings chaired by Supervisors Gjerde and Woodhouse and local professionals and advocates including the Sheriff without the CEO or mental health administrators to discuss a plan for Mendocino County that would avoid the usual politics and filters of innumerable past meetings that I have attended. The goal would be the most cost-effective locally controlled professional upstream programs for a very difficult problem affecting many patients in great need, where 5150s and jail admissions would be considered a failure of the system.”
SHERIFF TOM ALLMAN: “I represent the three city police chiefs and myself. We certainly believe that there could be some improvement made with mental health. In 1999 Mendocino County made a mistake. Mendocino County closed our only hospital [the Psychiatric Health Facility, PHF, or "puff" unit). We are in a contract situation where we have contracted with private enterprises to provide mental health services. I'm not going to sit here and tell you that everything that happens with these private services is bad because it's not. I believe that one certainly has fewer complaints than the other. But what I'm telling you is that Mendocino County has put ourselves in the passenger seat of a $20 million program with our mental health department. We are in the passenger seat, we are not in the driver's seat. We have to accept decisions that are made by private enterprises. It causes law enforcement to clearly say that mental health right now is the number one public safety concern in Mendocino County. If you don't believe that why don't you find a law enforcement officer that you know and ask him or her in our county how mental health is impacting their day to day activities. We have had situations where our 5150 form that we fill out is not accepted because they are completed in two different colors of ink, black and blue ink, because on Thanksgiving day the officer had to run out to another call and the chief of police from Willits had to complete a form with a different pen. And the form wasn't accepted. I certainly hope that for the amount of money that we are paying the private contractors to take care of the mental health situation that they are going get some direction from this board [pointing], all five of you, that is going to help solve the problem instead of having an ad hoc committee to kick the can down the road. Let me tell you what this board needs to do. It needs to build a building in this county where we can have mental health services provided in Mendocino County. We are paying a lot of money outside of this county to take care of our citizens where the law enforcement agencies at the jail and on the streets are basically the de facto mental health director many times a day. We are standing by at hospitals when the mental health department's private contractors can't get there. While I am not going to say that we should throw the baby out with the bathwater, we need to get to a point where Mendocino County is back doing the mental health services. What I'm saying is, as a person who sat on the RFP committee when we got to where we are right now, I don't believe that we would have ever envisioned the problems that we are having right now. So why don't you please listen to your constituents here. Why don't you please listen to law enforcement officers here. You should say, Where can we improve mental health services so that it's not the number one public safety issue of Mendocino County.”
Supervisor Tom Woodhouse: “I know we don't discuss and engage with public expression but I would like to request that we set this on our next agenda, for January 5, so that we can all talk about this.”
Supervisor Carre Brown: “You are probably going to be looking at standing committees for the coming year instead of the ad hocs that we've been doing so that will be a consideration and maybe during that time as well.”
Supervisor John McCowen: “We are going to have a report in January from Mr. Kemper and his associate. I think whatever agenda item or meeting that that item comes forward this can be can certainly be combined with it. I don't know why we would do the same thing twice.”
EXCERPT OF MAP found at OMG'S website: