NCMH Commentary

While it details non-compliance in meeting a court order that led to Piedmont Behavioral Healthcare being held in contempt of court, a September opinion from the NC Court of Appeals also cites the agency’s arguments that it is literally above the law, at least as far as the state’s mental health statutes are concerned.

And in ruling against PBH’s arguments that it is protected from court action by sovereign immunity, the Appeals judges added yet another interesting twist to the unique and dysfunctional chaos that is the state’s mental health system.

The Court of Appeals findings stem from a March 26, 2010, order from Davidson County District Court that PBH provide PRTF placement and other necessary services to meet the mental health needs of a minor child under DSS guardianship or to appear in court and explain why it was not meeting the order. DSS had been seeking services for the child since August 2009. [Read more...]

Piedmont Behavioral Healthcare (PBH) has finally honored North Carolina Mental Hope’s request for copies of minutes from its board of director’s meeting, a packet of printouts arriving last Friday. While I have not had time to delve into them, I finally made time this afternoon to respond to an email from Rep. Fred Steen’s office regarding its investigation into PBH’s compliance with the Open Meetings Law. That email, circulated to HHS LOC committee members and others, is repeated below, followed by my response to the conflicting, illogical and at times outlandish defense of PBH. [Read more...]

The question of whether Piedmont Behavioral Healthcare is playing legislators for fools would seem a fair one in light of an email from CEO Pam Shipman circulated to members of the Health and Human Services Legislative Oversight Committee regarding North Carolina Mental Hope’s July 26 request for minutes of PBH board of directors meetings.

Copies of that Nov. 3 email and the response this past Satuday after becoming aware of it are included below. Key points/counterpoints of Shipman’s response to an inquiry from Rep. Pat Hurley’s office:

• What Shipman says: PBH makes all records subject to public records law available upon request in accordance with state law.
• What the law says: Shipman includes the opening paragraph of Chapter 132 of the General Statutes, the Public Records Law but incredibly chooses to ignore the second part of the very sentence she offers to support her contention that PBH is complying with the law, the part that requires copies of records to be provided upon request. While the rest of Chapter 132 spells out a public entity’s obligations in meeting its provisions, those obligations are clearly and simply stated on the first page of the Attorney General’s “Guide to Open Government and Public Records.”

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Actions may speak louder than words, but silence often speaks louder than either.

With the 3-month anniversary of North Carolina Mental Hope’s request for board minutes of Piedmont Behavioral Healthcare just passed, it seems an appropriate time to ask what the silence of the LMEs administrators, of legislators and of advocates has to say.

The silence of PBH: It doesn’t take an advanced degree in common sense to have sense enough to ask what they’re hiding. And if not hiding anything, what does it say about the organization’s integrity that the prevailing mindset is apparently one of fear or uncertainty that something adverse to its interests might be found? What does it say about an agency’s integrity that it chooses to hold itself above the law? To me, it screams they have none. And yet, it is the chosen model for others to emulate in building the bedrock of our state’s system for the delivery of mental health, developmental disability and substance abuse services. [Read more...]

If opponents of increased powers for the new Super LME/MCOs would just look at the issue logically, they’d be hard pressed to argue that it’s any less logical than most other decisions made in connection with the state’s mental health system over the past decade.

With New River Behavioral Healthcare losses of at least $6.5 million while under the oversight of the Smokey Mountain Center LME, it’s only logical to make LMEs more powerful with less oversight of themselves.

With Piedmont Behavioral Healthcare flaunting the state’s Public Records Law now for almost three months in ignoring a request for copies of its board minutes and requiring nondisclosure agreements, it’s only logical to make LMEs more powerful, including exempting them from provisions of the Public Records Law. [Read more...]

While it may not be enough to earn an invite to Dancing With The Stars, Assistant DHHS Secretary Beth Melcher did show her mastery of the Raleigh Sidestep last week in answering a question on consumer inclusion from a member of the Health & Human Services Legislative Oversight Committee.

Asked by Sen. Tommy Tucker, R, District 35, if there were a fair number of people on the “task force” reviewing the Department’s strategic plan for waiver implementation, Melcher replied:

“I wish I knew of a perfect system to get everybody’s input. I don’t  know of anyone who’s discovered that.” DHHS needs to develop multiple ways of getting input, she said, adding there is indeed a mechanism in place for receiving input moving forward as waivers are implemented and that conversations are ongoing on the best folks to serve and the best way to get input.

“It’s certainly our intent to try and get a broad range of input and opinion,” Melcher said, then described the challenge of getting input from individual service recipients through customer surveys and town hall meetings. And while that particular input has nothing to do with the strategic plan, it makes it sound like much is being done. [Read more...]

A rose by any other name would smell as sweet, but for New River Behavioral Health Care CEO Pam Andrews, fraud by another name would be more accurate and sting substantially less.

In a statement dated Wednesday outlining the chronology of events that led to the agency’s closing, Andrews takes exception to the use of the word “fraud” by the Division of Medical Assistance to describe New River’s difficulties.

“Fraud is an alarming word on its own and is compounded when it is accompanied by financial concerns. An accusation of fraud can result from something as simple as a document that hasn’t yet been uploaded to a patient’s file or from much more complex and even illegal actions. New River has done nothing illegal.”
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Sometimes it’s important to note things if only to have them on record. Such is the case with DHHS Deputy Secretary Mike Watson’s comments Tuesday regarding proposed changes to provisions of Chapter 122c of state statutes governing Local Management Entities.

In presenting a broad overview of the issues DHHS says have arisen as LMEs become the new Super LME/MCOs (managed care organizations), Watson said: “The overall plan would be to come back in a session in November with a very limited request granting the Secretary the opportunity to perhaps waive some provisions of 122C and then to have the opportunity in the short session to have a more robust discussion about what changes might need to be made.”

And while Watson told the committee the same thing a bit later as well, that’s not necessarily a reason to believe proposals dramatically changing the nature and power of LMEs won’t pop up during next month’s special session anyway, introduced by a legislator at special interests request. During his presentation, Watson noted areas for change might include: board size and composition, the role of the executive committee, pay, fund balance restrictions, the ability to own property and borrow money. [Read more...]

With the announced closing of New River Behavioral Health Care, the mayhem that is the only constant in the state’s mental health system has claimed yet another victim.

According to news reports, the former LME that morphed into a provider agency after its July 2007 merger with Smoky Mountain Center is almost $3 million in debt and being audited, with commissioners from the counties served holding emergency meetings to see how best to continue services to the agency’s 13,000 clients and hopefully retain jobs for its 300 employees. And, of course, they’re trying to sort out who’s responsible for the agency’s bills as well.

Beginning in the ’60s as a community mental health center, the reasons for New River Behavioral Health’s demise are likely complex and varied. But before the agency becomes just another footnote to more than a decade of chaos, it’s worth considering how the continued consolidation of providers and LMEs may have affected New River’s financial health. At the very least, it’s worth considering the power that LMEs have to make or break an agency. And on the surface at least, the decision by Smoky Mountain Center to award a contract for services in its Central Region to RHA Health Services could be seen as the final nail in NRBH’s coffin. [Read more...]

Not content with just being the model for the restructuring of the state’s MH/DD/SAS system, Piedmont Behavioral Health is apparently ready to take a wrecking ball to a system already teetering on collapse. In a planning document dated 9/26/11,“Proposed Changes to 122C and Public Authority Comparison Chart,” proposed changes would:

• Remove requirements that county commissioners serve on LME boards as well as requirements for geographical representation
• Remove counties from virtually any control over LMEs
• Exempt LMEs from the Local Government Finance Act and remove fund balance restrictions
• Allow LMEs to purchase, hold title, improve and finance real estate
• Grant exemptions to the state’s Public Records Law that keeps LMEs from controlling the use of intellectual property
• Allow LMEs to “take advantage of any emerging opportunities” in introducing new product lines and services
• Exempt LME staff from the State Personnel Act and remove salary limitations
• Have Medicaid waiver appeals heard by a DMA hearing officer rather than the Office of Administrative Hearing

[Read more...]