Who Needs A Needs Assessment?

After spending several opening minutes last Wednesday, March 28, on a pointless discussion of a Mission Statement — which ended up being a reference to the text of the Measure anyway — the Measure B Oversight Committee got down to some contradictory discussions designed primarily to put the old Howard Hospital on a fast-track for conversion into a reincarnation of the County’s old Psychiatric Health Facilty, PHF or “Puff” unit.

On the one hand, while Committee Chair Sheriff Tom Allman has been pushing for a consultant to do a “Needs Assessment” before any money is spent, Howard Hospital Foundation Chair Margie Handley and her crew of contractors, architects and consultants have already proceeded to spend tens of thousands of dollars on fairly detailed plans to convert the old Howard Hospital facility into a PHF.

The Handley crew has already developed a specific floor plan and building design and cost estimate for a 16-bed facility proposal which they said would “turn the old hospital into what the county wants.”

Handley’s “project manager” (whose name and construction outfit we couldn’t catch because the sound quality of the video was poor for people speaking at the podium) said that he had received a “list of needs” from the county which he'd used to determine room configurations, code issues and plans which made up the contractor’s “proposal.” These specs, he said, could easily be converted into plans for an $11 million to $15 million upgrade/remodel for PHF II. The cost range was derived from “market rates” for labor and $15 million if pegged to government specified “prevailing  wages” for labor.

Nobody in the room was concerned about this seeming cart-before-the-horse proposal. Instead, committee members were more interested in a) how soon the facility could be built; b) how accurate the cost estimate was and c) what kind of security was anticipated.

Answers: a) Much sooner than if they had to start from scratch; b) Costs could go up; and c) a 12 foot chain link perimeter fence will enclose the PHF.

Huh? We thought that’s what the needs assessment was supposed to determine.

One explanation came from Willits physician Dr. Ace Barash who pointed out that “Treatment needs are self-evident. … A locked facility is obviously needed. We don’t need Lee Kemper for that.”

Lee Kemper is the consultant the County hired a couple of years ago to provide justification — as if any was needed — to oust the Ortner Management Group whose privaitzed Mental Health “Services” were so costly and limited that nearly everyone with an opinion on the subject had decided that Ortner had to go. Predictably, for almost $50k, Kemper recommended that Ortner had to go. Several of Kemper’s other recommendations — a formal system of accountability, formal memorandums of understand with associated groups and agencies, retention of some services by the County, etc. — were ignored or only partially implemented.

Sheriff Allman responded, “Lee Kemper already has a lot of numbers that we’re looking for.” (He does? Then why didn’t he hand them over at the end of his last consulting contract? And why doesn’t the County’s mental health staff have those numbers already?)

In February’s Measure B oversight committee meeting, County CEO (and committee member) Carmel Angelo was cautious about committing to hiring Kemper for the needs assessment because she was worried about his availability. But in the latest meeting, that “problem” was magically solved because unbeknownst to the CEO her own Mental Health Department had hired Kemper for another $25k consulting project, and all they’d have to do is get the Board of Supervisors to approve adding another $40k for the Measure B needs assessment.

The charitable Kemper, CEO Angelo added, won’t charge the full $40k if he doesn’t have to. (Hell, he shouldn’t have to if the Howard Hospital PHF conversion is a predetermined “need” and off the table.)

Toward the end of the meeting, in response to a question about current outside placement costs for the mentally ill asked at the February meeting, County Mental Health Director Dr. Jenine Miller, reported that Board & Care costs for out of County conservatorships were $2.2 million last year paid by realignment dollars. “None of that is billable to MediCal because of the IMB (?) exclusion,” Miller added without bothering to explain what an IMB exclusion is. But, “with a 16 bed facility we could bill MediCal up to for up to [15%, 50%? 58%? Poor audio quality] or more of that cost.” Miller said that Mendo now has one board and care facility in county, “but we can’t bill MediCal for that.”

Then Dr. Miller confused matters further by noting “that is just out of county costs, it’s about $1.5 million to place people in facilities outside this County for Board and Care. Then there are psychiatric hospitalizations, 5150s, sent to out of county facilities, which cost about $1.8 million.”

So how much is it? Nobody asked for clarification. If Ms. Miller had said $100 or $10 million or anywhere in between I wondered if anybody would have challenged her math. Nobody asked for a written breakdown, nobody asked why the numbers didn’t add up, nobody asked how many placements that represented, how many would it be if they had a local facility, how many really needed out of county placement, etc.

File it under “sorry we asked.”

There was a brief discussion about the other mental health facilities that are expected to be in the pipeline in the next couple of years: A Crisis Center on Orchard Avenue in Ukiah and a new mental health wing at the jail.

Redwood Quality Management Company honcho Camille Schrader said that there are some distinctions that need to be made regarding the various types of facilities:

“We’ve had lots of conversations of types of facilities,” said Schrader adding that the crisis center is for the first 23 hours for “stabilization.” Then later the “patient” might be shuttled to “longer term facilities” if they are “severely mentally ill.” But, Schrader added, “there are not that many longer term facilities for severely mentally ill which are certified for MediCal.” And then there are the “dual diagnosis” patients with both mental illness and drug or alcohol problems. And there are also the drug and alcohol only… Schrader thought that depending on how the PHF is set up, there might be cases where a patient could improve to the point that they could “walk across the hall” presumably from the locked PHF facility to a more board and care style facility right there at Howard Hospital!

Of course, these fine distinctions are highly subjective and variable and subject to lots of fuzzy decisions that only the insiders know about. Obviously, the County’s “needs” will end up conforming nicely with whatever capacity is provided, no matter what the “needs assessment” says.

The whole process is starting to look like the dog and pony show some Measure B critics have predicted it would be: convert the old Howard Memorial Hospital into a new PHF and then spend whatever’s left over on whatever comes up.

Sheriff Allman concluded the meeting by handing out copies of Robert’s Rules of Order to the committee members. Clearly, you can’t have an unneeded needs assessment, much less a reconstituted PHF unit, without the proper motions and seconds.

Commenting on the March 28 meeting on the AVA’s website Willits based commenter “Lazarus,” offered this rather negative summary of the meeting:

“I saw a still of the Measure B meeting shot form the back of the room. The only audience was Marge Handley and her stooge Arnie Mello…I think that’s his name. I’m wondering where the money comes from to staff the 100 year old crumbling HMH behemoth…Let’s be clear here, this Howard foundation bunch wants one thing—to unload the old building. Handley is cutting ties with Willits proper. She’s sold her fancy ass Haehl Creek house, which was gifted. She’s sold another property in the vicinity of HMH I hear, and everything else is on the block. She’s gett’n her hat and getting out. When the lame committees, commissions and boards finally figure out how she f***ed them out of the money she’ll be hide’n out in India…or her estate east of Willits.

"Rumblings from the community have started, parents of kids attending neighboring schools have concerns, as do the police. And then there’s the neighborhood. Handley has made it clear she care’s not about anyone in the sphere of influence. To date folks I know near HMH have never been contacted or considered, Handley is in it for herself, the City knows it, the cops know it, and many in the community know it.

"Nevertheless the beat goes on. All this unfortunately will likely be piss’n into the wind for the folks of Willits. Handley’s last deal will probably kill what’s left of the Willits community, anyone who thinks different is either a liar or a fool.

"This is one of the biggest cons ever run in the Mendo. Shame to all of them!”

Oh well, at least Mendo might (and we emphasize “might” because there are still some very critical hurdles to overcome like land acquisition and staffing) get a new PHF unit out of it. After all, that was really the point in the first place, wasn’t it?