Sunday, July 22, 2012

Mendocino County prepares to respond to grand jury

Ukiah Daily Journal Staff

The Mendocino County Board of Supervisors is set to finalize its responses Tuesday to grand jury reports on the county's mental health system, law enforcement, retirement system and Teeter Plan, among other things.

After the grand jury's annual report comes out every year, the Mendocino County Board of Supervisors has 90 days to respond. Interim County Counsel Terry Gross prepared responses to six reports for the board to review and finalize.

A report on the Mendocino County Health and Human Services Agency's Mental Health Branch says the branch balanced its budget this year after years of deficit spending.

"They did this largely by eliminating programs, cutting personnel, limiting client services to those that are mandated for the seriously mentally ill and redirecting other clients to contracted and non-contracted service agencies," the report states, going on to conclude that the county's mental health system "fails to meet the needs of its citizens."

In one of its 26 findings, the grand jury states that the current and past employees, physicians, board members, case managers, directors and others interviewed said they believed management direction reflected "that if a program is not self-supporting, then it should be eliminated."

The Board of Supervisors' response disagrees.

"Several non-mandated programs have been restructured or discontinued in response to budgetary constraints, but mandated programs, which are not always self-supporting, are not eliminated for budgetary or for any other reasons," the Board of Supervisors' response says.

The board based its disagreement with four of the grand jury's findings on a response -- included only by reference -- from HHSA Director Stacey Cryer, including a finding that a renegotiated contract with a vendor that transports mental health clients to out-of-county mental health facilities resulted in a "long waiting period," and a "minimum of four hours" for clients on the coast.

The grand jury also found that county Mental Health recently moved in with the county's Public Health immunization clinic and Alcohol and Other Drugs Program on Dora Street, and that the move meant there was only one check-in windows and a small waiting room for "mental health clients, clients coming in for drug testing and children arriving for immunization, (making) confidentiality ... difficult to maintain."

The board's response says construction delays caused a "temporary lack of appropriate check-in window and waiting room space," and says the problem has been fixed.

Responding to a finding that Mental Health administrators issue "top-down directives" without getting enough input from employees, stakeholders and board members, the Board of Supervisors said that while "some individuals" have a "persistent perception" of a top-down approach, "there are numerous examples of efforts to more fully involve staff and the community."

The grand jury also finds that the state's annual MediCal audits have a four-year lag time and find mistakes in the billing process that accrue penalties during the lag time, and that those penalties have been "a huge financial drain" to the county's mental health system.

"Due to staffing shortages at the state level, these audits are conducted six years after the fact," the board's response says. "Mistakes do not accrue penalties -- it is the audit exceptions themselves (money the county must pay back that the state determines the county wrongly billed for MediCal reimbursement) that have been a financial drain."

The board also says the county has already completed four of the grand jury's recommendations, including training Mental Health administrators in mental health issues, making "consistent goals" and communicating transparently with clients, staff and the public.

The other recommendations the county says it has already done are setting up and monitoring "clear interactive roles and responsibilities between medical records and staff;" hiring "additional qualified personnel;" and having separate check-in windows and waiting areas "for the diverse client population."

The county response says three of the grand jury's recommendations will be done down the road, including upgrading or replacing the computer system to save personnel time and cost; being able to generate financial reports with specifically requested information that are "clear, concise and easily readable by the community;" and providing local housing for clients who are returning from out-of-county mental health placements.

The board's response says more research is needed for a grand jury recommendation that "Human Resources use language that is more specific in employment advertisements for qualified (mental health) personnel, particularly licensed clinicians, listing the experience and education requirements for job openings," in addition to civil service requirements.

The board says it will not implement the grand jury's recommendations that the county use general funds to buoy client services, and restore psychiatric services for jail inmates and youth to last year's levels, before the jail psychiatrist resigned, saying those recommendations aren't reasonable.

The county says psychiatric services weren't cut in juvenile hall, and restoring previous levels of service in the jail would be the sheriff's decision, not Mental Health's.

The grand jury also recommends that "Mendocino County health clinics that are already serving large numbers of (mental health) clients respond to the HHSA (request for proposals) to privatize county (mental health) services when issued."

The board responds, saying that recommendation can't be implemented "because it is not warranted or reasonable in that the Mendocino County Board of Supervisors has no authority to direct actions of the health clinics."

Other grand jury reports for which the Board of Supervisors will discuss and finalize its responses include a report on the Teeter Plan, an evaluation of the Mendocino County Employees Retirement Association, and update on county emergency services, an assessment of law enforcement and a report on rubberized asphalt concrete.

No comments: