Implementing the Kemper Report

The Supes Voted 3-2 Last Tuesday to implement the Kemper Report, over the objections of Supervisors McCowen and Hamburg.

Our interpretation of the Supes’ remarks as they discussed the Kemper Report on what has gone wrong, very wrong, with privatization of County Mental Health is that Supervisors Hamburg and McCowen are equivocating, Supervisors Gjerde, Brown and Woodhouse recognize a disaster when they see one and that action to fix it needs to begin now.

It should also be noted that Supervisor Hamburg has benefitted from thousands of dollars in County-paid mental health services from the Ortner Management Group for his son, which would be a legal conflict of interest any place but Mendocino County.

After insisting that he wasn’t an apologist for Ortner, Hamburg sarcastically, but incorrectly, claimed that the three Supes who were unhappy with Ortner were smarter than the expert, Kemper. Hamburg added that his own son had received “pretty good” service from Ortner and that Ortner’s service was an improvement over the County operated mental health system. But he didn’t think Ortner’s clients could be just handed over to Ukiah-based Redwood Quality Management without serious consideration.

McCowen said he mostly agreed with Hamburg, adding, “If you had a two-and-a-half year old car and the transmission went out you would probably tow it to the shop and get the transmission fixed. You wouldn't tow it to the junkyard and scrap it. So we are scrapping a solid foundation and I fear plunging the clients into uncertainty and I'm not sure why we would do that based on information in front of us.”

Supervisor Dan Gjerde was obviously has had enough of Ortner’s unmet promises quipped, “But you would dispose of it if that car was a lemon.”

Supervisor Woodhouse rambled a bit but basically said that if Kemper had gone back five years instead of just three they would have concluded that Ortner’s service was worse, not better than pre-privatization. Woodhouse said he had data showing that Ortner was delivering about 75% of what the County had. Woodhouse added, “I hope that Ortner does put a proposal in. They have a tremendous advantage. They know our needs. They have gone through the pain of being here and listening to us for years over this. … We are not disrespecting or throwing aside the Kemper report. We wouldn't be here, we wouldn't be this close to doing something this important without that input. I hope that you are thinking of hiring them as a consultant to help us through this process.”

Gjerde and Woodhouse made it clear they wanted to proceed with the previous plan to implement the Kemper recommendations by working on Kemper-recommended contract amendments with Ortner. McCowen and Hamburg were for letting things ride for awhile while an RFP was prepared over the next few months. Carre Brown found herself in the position of swing vote. Brown said that Ortner and County staff had already had plenty of time to improve the situation without success and so Brown wanted to “move forward” with the Kemper recommendations.

So the Supes finally voted, 3-2 (McCowen and Hamburg dissenting, to both implement the Kemper recommendations via modifications to Ortner’s contract whether Ortner liked it or not, and finish the improved RFP to put the County's adult mental health services out to bid as soon as possible. McCowen and Hamburg voted for more of the same.

Public Comment was almost unanimously in favor of dumping Ortner with most of those proposing that the Board simply turn the Adult Mental Health services over to Redwood Quality Management via a contract amendment.

At earlier day-long meeting to go over the Kemper Report Ortner’s Mark Montgomery said they would be willing to re-write their contract and work to implement the Kemper recommendations. One close observer of the situation told us that it was unlikely Ortner would be so cooperative with a three-vote majority that is unhappy with their performance. “There is less than a zero chance that Ortner is going to have any interest in re-writing the contracts to give the County more control. Or do anything else to improve service. And it won't be any surprise if he beats the county to the punch in giving notice that he is outtahere — way outtahere. … Until Ortner is replaced someone needs to keep providing services to the clients. … Don't expect Ortner to be doing any favors for anybody on their way out the door.”

A way forward?

Remember, Ortner did not have in-house capability for adult outpatient or crisis care in Mendocino County, so Ortner quickly subbed that work out to various local providers many of which had previously contracted with Mendo before privatization.

In effect, with the help of former Ortner executive Tom Pinizzotto, newly positioned as Mendo’s Mental Health chief, arranged it so that Ortner inserted themselves into an existing County administrative function, adding an expensive, duplicative and unnecessary layer.

This entire arrangement needs to be re-thought.

There was clearly a need to privatize the billing process to reduce the high percentage of rejections by the state.

There was also a pretty good reason to “privatize” residential care — if that care could be provided in facilities inside Mendocino County.

You could even make a case that some outpatient care should be privatized because of staffing difficulties.

But there never was a documented need to “privatize” mental health administration and in the process add an expensive duplication — why does Mendo need a private contractor to simply turn around and farm out work to Hospitality House or Manzanita services?

If the County wants to “fix” the problem with the delivery of adult mental health services, they should do a topdown integrated plan involving all aspects of mental health, law enforcement, the courts and drug abuse, not just tweak the RFP and ask another set of bidders to continued duplicating administrative functions. Then after that review, privatize the things that really need to be privatized — primarily medical billing where there are a number of professional outfits around which could be paid a percentage of their successful bills at much lower cost than any large mental health services company could.

Remember also that the Ortner contract calls for Mendocino County to train Ortner in how to bill for adult outpatient services. The same County staff that couldn’t get billing done right before was supposed to train a Contractor which, as a professional services organization, shouldn’t have needed such training in the first place.

As it stands, there’s still a very good chance that in a year or two the State will discover another year’s worth of unacceptable mental health bills — this time for Ortner’s alleged services — and demand yet another few million dollars back.

Will Ortner even be around when that happens? And if they are, will they simply point at the County and say, “It’s your fault, you were supposed to train us.”

* * *

Ukiah Daily Journal Editor KC Meadows contributed this editorial to the discussion last Sunday:

Mendocino County Supervisor Dan Gjerde is right to lead the effort to get the county to issue a request for proposals to find a contractor for county adult mental health services who will do a better job than Ortner Management Group has done in the three years it’s been under contract.

We disagree with Supervisors Dan Hamburg and John McCowen who want to stick with Ortner, saying Ortner would have no incentive to improve its services if it feels it is being shown the door anyway.

First of all, if they think Ortner would — or should — take that attitude, then as far as we’re concerned that disqualifies Ortner as a service provider.

And, Ortner has lots of good business reasons of its own to want to look as though it is cooperating with Mendocino County to provide the best possible services.

As other supervisors pointed out, Ortner would be welcome to put forth its own new proposal under the RFP process, although we wonder if they would want to stay on under the likely reduction in profit motive in a tighter and heavily directed new contract.

We understand why Mr. Hamburg is in the tank for Ortner. He has a family member under their care and is convinced by the lukewarm review from the independent Kemper consultants that mental health services have improved somewhat under Ortner. But what he doesn’t seem to get is the conviction from dozens of local doctors who deal with mental health patients that many of Ortner’s low-paid staffers just don’t care, and work for a culture that permits that.

Mr. McCowen on the other hand, seems to feel that the county will look unreliable to other potential contractors if it dumps Ortner now. We take the opposite view, that what the county is doing is showing contractors that it knows how to correct its mistakes and will not let contractors who disappoint it off the hook.

The county needs to have an RFP ready to go quickly and should get Kemper to help them draw up a watertight document.

Next, the county still needs to do its part to improve services as well. It needs to pursue the exciting and very real prospect of having the old Howard Hospital in Willits transformed into a locked psychiatric care hospital rather than continuing to send our critically mentally ill off to far flung counties at great expense. Then the county needs to hire at least one if not two people who will be responsible for administering the contract and making sure that whoever is providing adult mental health care — with millions of our dollars let’s not forget — is doing it dependably and responsibly with care and transparency.

(Courtesy, the Ukiah Daily Journal)