MENTAL HEALTH FIXES URGED; SUPERVISORS WANT PROBLEMS IN PROGRAMS RESOLVED.

Byline: Krystn Shrieve Daily News Staff Writer

Stung by criticism of Ventura County's once-stellar mental health system, supervisors said Wednesday that the programs need to be overhauled - and quickly - to resolve widespread problems and retain $5.4 million a year in state funding.

``The big picture was that we've sunk to a new low,'' said Supervisor Frank Schillo. ``We need to change direction. We need to say, Yes, we want to participate for state funds and we want to be the best again. The only way we have to go is up.''

Yet even as they called for sweeping changes, officials remained supportive of Pierre Durand, director of the Health Care Agency that oversees mental health programs, and Dr. David Gudeman, the acting head of the Behavioral Health Department. Some said they considered the audit a political attack on the two mental health officials.

``It's a wakeup call, a heads-up, that we need to deal with these issues one at a time,'' said Supervisor Judy Mikels. ``Other parts of the report look like an absolute witch hunt for the heads of David Gudeman and Pierre Durand. And that just ain't gonna happen.''

The audit was launched by the California Department of Mental Health at the insistence of state Sen. Cathie Wright, R-Simi Valley, who alleged fiscal mismanagement in the mental health department and blamed Durand and Gudeman.

The report sharply criticized the county's Systems of Care, which served as a model for the rest of the state when they were created in 1984. Those programs have deteriorated to the point that county officials were advised to consult with other counties to figure out how to improve and salvage their state funding.

The chairman of the Mental Health Board, an advisory panel to the supervisors, said he was embarrassed by the suggestion that Ventura County needed to look elsewhere for guidance.

``This is not going away until we have the right leadership,'' said John Chaudier, who frequently has butted heads with the supervisors. ``We need to take a look at a different type of leadership because the leadership we've had in the last six years since I've been here is not the kind of leadership we need.''

Schillo blamed the problems on Stephen Kaplan, who was ousted in February as director of the Behavioral Health Department after he orchestrated an unsuccessful merger with the Public Social Services Agency. Schillo said the Board of Supervisors had no idea the system they helped build had eroded.

``Kaplan never told us a thing,'' Schillo said. ``And then he tried to merge to cover up more of the mess, figuring he could hide it.''

Supervisor John Flynn agreed that the board's knowledge of the mental health operation was based primarily on reports from department managers.

``We relied too much on the pictures painted by our staff,'' Flynn said. ``We didn't talk about it enough - usually only during the budget process. It was ultimately our responsibility.''

But Chief Administrative Officer Lin Koester said that two years ago he alerted the supervisors to many of the problems that were outlined in the audit.

``Had the board acted in accordance with my recommendations we would be well on our way to correcting these problems,'' Koester said Wednesday, shortly after the audit was released to the public.

But Mikels said she believes that officials need to ``step back and stop the finger-pointing'' so that problems can be resolved. ``We need to bring everyone to the table and work it out.''

As for the fiscal concerns raised by Wright that triggered the audit - she suspected that money earmarked for mental health programs had been spent at the Ventura County Medical Center - the report said the transfers complied with state rules.

Still, Wright said she felt vindicated by the state's findings and feels it confirms her belief that Durand and Gudeman are poor leaders.

``Neither one of them have any knowledge of Systems of Care,'' Wright said Tuesday after the report was being circulated. ``Nor do they care to know.''

Durand refused to comment, referring all calls to Koester.

The county now faces a series of deadlines to comply with the report's recommendations. It has two weeks to submit corrections or request clarification from the state and must decide by July 1 whether it wishes to remain in the Systems of Care program. It has until Aug. 1 to create a strategy for how to comply with state recommendations.

Flynn said he would be willing to give up the state funding - which amounts to about $5 million - if meeting the state requirements doesn't fulfill local needs.

``There are a lot of changes we have to make and we need to make them quickly,'' Flynn said. ``Gudeman is the man for the job and he can put together a plan in 15 days.''

STATE REVIEW

A summary of findings from the state Mental Health Department review of Ventura County's Mental Health System.

Both the children and adult Systems of Care have deteriorated and failed to keep pace with statewide advancements. Top management is neither supportive nor knowledgeable of these programs.

An atmosphere of fear and initimidation contributes significantly to many of the current problems, as does a high employee turnover rate.

An exceedingly high proportion of psychiatric services are provided at the county hospital to those who do not need acute care.

Physician authority and involvement in administrative decision-making has eroded and requires correction.

The county has failed to develop innovations in children's care despite receiving twice as much money as similar-size counties to do so.

CHRONOLOGY

Following is a chronology of the problems facing the Ventura County Behavioral Health Department.

JUNE 1997 - During budget hearings, Supervisor Susan Lacey proposes merging the Behavioral Health Department and the Public Social Services Agency. The idea had been pitched by Behavioral Health Director Stephen Kaplan, who said his department and the PSSA already served many of the same clients.

MARCH 16, 1998 - Deloitte & Touche, the Sacramento consulting firm hired by the county to analyze the proposed merger, says it would violate federal Medicare regulations and could cost the county $15 million a year in reimbursements. Kaplan reassures officials there will be no problem.

APRIL 7, 1998 - After a brief public hearing, the Board of Supervisors votes 3-2 to create the $171 million-a-year Human Services Agency. Supervisors Lacey, John Flynn and Kathy Long vote in favor, while Frank Schillo and Judy Mikels are opposed.

DEC. 21, 1998 - The federal Health Care Financing Administration says the merger violates federal regulations for reimbursement of medical expenses. It opens an investigation to determine whether $15 million in reimbursement claims should be honored. That investigation is ongoing.

DEC. 22, 1998 - The Board of Supervisors votes 4-1, with Lacey dissenting, to dissolve the merger.

JANUARY 1999 - The U.S. Attorney's Office launches an investigation into Behavioral Health's Medicare billing practices. Officials say psychiatrists' billing numbers were used by social workers and other employees to authorize treatment for patients the doctors never saw.

JAN. 29, 1999 - Kaplan is placed on a 30-day leave by Health Care Agency Director Pierre Durand.

MARCH 1, 1999 - Kaplan resigns. His top deputies, Kevin DeWitt and Judy Balcerzak, leave shortly after. Dr. David Gudeman is named acting director of Behavioral Health.

MARCH 2, 1999 - At the request of state Sen. Cathie Wright, the state Department of Mental Health opens an audit of the county's programs to determine whether the $5.4 million it receives each year is being spent properly. Wright, R-Simi Valley, contends that money earmarked for mental health programs has been siphoned off for the county hospital.

MARCH 8, 1999 - County Auditor Thomas Mahon releases his financial review of county mental health services, showing a $430,500 debt. The report, however, concludes that Durand had not misappropriated money from mental health services for the county hospital.

JUNE 1, 1999 - The state Department of Mental Health releases its report, which recommends that the county be stripped of $5.4 million unless it improves its system for treating the mentally ill.

CAPTION(S):

2 Boxes

BOX: (1) STATE REVIEW (See text)

(2) CHRONOLOGY (See text)