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.
Pinizzotto didn’t sell Ortner or ASO’s to the County. The County was shopping for solutions, as the Kemper Report pointed out, the County is better off than it was because of the ASOs.
The County neglected to have it’s MOUs and contracts in place because Mr. Pinizzotto, under the direction of Cryer, who resigned as well, decided that the way to do business was to set up shop and then write the rules. This was a huge concern for Redwood, apparently who changed their tax from an LLC to an Inc, to write MOUS and protect their subcontractors. Ortner was doing whatever Pinizzotto (the County) said (which is not a good connection for Mrs Shaw right now).
The fact is, Mendocino has capable, willing, able, compassionate and experienced people to do the job without having to contract services, it’s just that there is no local ASO being formed for that to happen, and the County has is not going to reverse to more employees because it’s unable to pay the employees it once had long ago. The ones working today wonder every day if this is the last day because the lack of stability and all the shenannigans and “group think”.
Maybe you have something to replace ASOs that I missed besides what didn’t work before the ASOs?
According to the Schraeders at the last BOS meeting, RQMC has only four staff members, the Schraeders and two others. They provide no direct services.
I think the County could do a lot better job administrating services for much less than the 7-9 million dollars we pay RQMC to do so now.
Because there are so many other funding sources available for children, we could divert some of that RQMC money back over to the Adult System of Care where it is so desperately needed.
If we keep building services for children, where are we going to get all the children from? From the parents that we are not serving? If I were the king of the world, I would suggest that the County really examine “need.” Do a needs assessment if you will. Mental Health/Substance Abuse treatment for adults would negate the need for so many children’s services and make a lot more of the little ones much happier at the same time.
I actually went to college to be able to figure things like this out.
James Marmon MSW
What I don’t get about the Kemper Report is why the County Counsel was not overseeing the ASO contracts worth millions. I think everyone was kinda dumbfounded by what Kemper was saying, in that in made sense to get a contract manager, but how have we come so far for so long without one? Becuase county counsel would have overseen the contracts. Isn’t that their job? So what job does County Counsel do if not overseeing contracts worth millions?
Losak, Cryer, and Mr. P, all gone, who’s next? People need to speak out and clear their names.
Sheriff Allman began his statement by referring to four “Ms” that occupy his thoughts on a daily basis: meth, marijuana, mental illness, and money. Administrative services provided to consolidate costs for operations (what we used to call “overhead”) make sense but I thought that was pretty much the entire job of the some departments already (Admin — headed by Angelo, Auditor/Controller, County Counsel, Purchasing, Personnel, and something called “Risk Management”). [In Lake County, Risk Management is a function of the County Counsel’s department, and separate departments have their own administrative services.]
I think the entire system of administration in small rural counties should be reviewed to show how much public money is being misspent on diversion of funds to “overhead” instead of direct services, not to mention for pet projects (supporting friends of the elected officials and top-level staff) and unproductive wild goose chases (“marketing” for local industries, each with their own budgets and service providers already).
“Public sanitation” departments — law enforcement, social services, mental health, front-line emergency responders, and public health — struggle for funding while upscale marketeers “celebrate” the arts of environmental destruction and exploitation for the benefit of a few.
I’m guessing the shift to new Medicare/Medi-Cal reimbursement schemes have overtaxed the internal organs of county governance, for which we are quite grateful that the people of Mendocino County are willing to serve as citizen-partners in delivery of critical programs.
There is something entirely screwy about the standard “five white guys” (female representatives notwithstanding) type of “leadership” that requires little or no training of “electeds” and allows for behind-the-scenes crafting of administrative monsters like the Mental Health Services Act (Prop. 63) spending for programs that cannot — because of “confidentiality” and “personal privacy” rules — be measured against the actual costs of doing business and productivity standards.
We cannot even get the attention of the State Controller’s office or the Senate Committee on Local Governance to scrutinize the misuse of funds provided by property taxes for undelivered public services, here in Lakeland. It’s a real grind, what you all are doing, but really matters if we are to retain the intent of the Ralph M. Brown Act (http://www.leginfo.ca.gov/cgi-bin/displaycode?section=gov&group=54001-55000&file=54950-54963):
“54950. In enacting this chapter, the Legislature finds and declares that the public commissions, boards and councils and the other public agencies in this State exist to aid in the conduct of the people’s business.”
When governmental bodies behave as though the programs, services, and funding process they oversee “belong” to them exclusively, and the public — including its perversely “stigmatized” members like Mr. Marmon — is excluded from determining the whys and wherefores of systems gone awry, “the people” must demand (over and over again) correction of bad management practices.
What kills me is the individual complacency and smug self-satisfaction of public employees in the face of honest appeals for critically-needed services. Sheriff Allman is one of the few real “leaders” I have seen in many a year, who clearly does not mind taking responsibility for his job. Thanks to you all, and long live the AVA.