Tuesday, February 27, 2007

Evolving Story of the Problems at Mountain Valley Mental Health

Mountain Valley Mental Health (MVMH) is the provider of mental health services for Baker County. Their $1.8 million contract is up for renewal annually and is, according to Commissioner Kerns, the largest category in the County budget.

The following story by Baker City Citizen watch-dog extraordinaire, Gary Dielman, was written on January 24th of this year. It provides much of the detail and background material that was not reported on by the local papers while the problems were festering at MVMH over the last few years. The papers largely avoided the story, until, due to the tenacious commitment and efforts of the local citizens group called Healthy Mental Health (HMH), the problems could no longer be avoided. [Disclosure: I, Chris, am a supportive, if not so active member of HMH]

To their great credit, “The Record Courier” printed the following letter in its entirety. Gary’s article provides a revealing glimpse of how local “good-old-boy” networks appear to protect each other’s interests while neglecting their regulatory responsibilities. If not that, then common negligence is the best face one can put on it. In the process, good people and innocent bystanders are put at risk or hurt, and taxpayer dollars may be wasted. Reporting on the activities of these powerful local networks is routinely avoided by the local papers, leaving one to wonder if the papers identify themselves with, or see themselves as a part of, these local elite interests.

One example of the kind of biased reporting we have come to expect from the Baker City Herald was a February 8th report by reporter Mike Ferguson on a County Commissioner’s hearing concerning Mountain Valley Mental Health. As usual, the article (“Group Wants County to Cancel Contract”), deferred to government sources and the powers that be at the expense of reporting on what was said by concerned citizens during the hour plus long presentation. Mike gave a state regulator and the Commissioners 15.25 column inches while the HMH presenters who did most the talking during the hour plus long hearing got 6.75". MVMH Board chair, Dr. Larry Levinger, was given 3.5 inches, and he didn’t even attend the hearing.

Also, Mike did not report on Oregon Trail Electric Cooperative founder Peggy Timm's comments about the ease with which a qualified replacement agency could be formed--just the State bureaucrat’s negative remarks about canceling the contract. Mike also quoted a MVMH client about how change caused by bringing in a replacement agency would negatively affect clients, but he didn’t offset that by mentioning that change due to high turnover has been affecting past and present clients negatively, and is one of the issues repeatedly brought up by HMH. He also neglected to mention that there have been other clients come forward who did not like their experience at the agency after their long-time therapists and others left. These are just some of the problems with that article and Herald coverage of the issue in general.

Baker County Blog will be commenting the Herald’s continuing coverage of this issue and there are plans for future contributions on the subject from HMH members.
Failure of Adequate Oversight of MVMH Program at all Levels
by Gary Dielman

A week ago the State released a draft report of its December site review of Mountain Valley Mental Health (MVMH). Unlike all previous site reviews, which found MVMH in substantial compliance with statutory and regulatory rules, for the first time MVMH was “found to be not in substantial compliance.” That, to say the least, is an understatement of the findings, which are, in my opinion, a major indictment of the operations of MVMH. I will not address the site review further. The full report is available at the County Commission office in the courthouse.

The comments that follow answer the question: How did MVMH come to this sad state? How did it happen that a majority of the most qualified staff at MVMH either quit or were fired in the space of a year’s time? The answer, I submit, is the result a failure of oversight from lowest to highest levels. I’ll start at the local level and work up.

MVMH Administration and Board Level.

Over a period of years, employee’s complained to the Board of Directors of MVMH (Board) about former director Tim Mahoney. The Board either ignored the complaints or took no effective action. In either case, the employees received no feedback about their complaints. The abuses continued.

Out of total frustration, the employees banded together and presented to the Board a long list of complaints about Mahoney and the practices under which the program was being run. [Allegations were made as follows:] Mahoney was misdirecting MVMH staff, materials, and finances to his personal gain with no relationship to the mission of MVMH. With respect to his official duties, Mahoney failed to fully implement action plans required after State and Greater Oregon Behavioral Health, Inc., (GOBHI) site reviews three years ago, such as the requirement that MVMH develop and distribute to employees a policy manual. Mahoney and the Board failed to make sure MVMH complied with mandatory State and GOBHI action plans. During the most recent site review in December 2006, the State found the issues of three years ago still unaddressed.

The employees’ request to meet with the Board to discuss their concerns was turned down. After the employees hired an attorney to assist them in confronting the Board, last February the Board took action by demoting Mahoney but kept him on in a high level position with duties of dubious value to the organization and replaced him with a therapist who had worked under Mahoney for twenty years. The result: many employees saw no change in what they felt was an insufferable working environment and quit. One very experienced employee, who wouldn’t quit complaining, was fired.

In essence, the Board sacrificed the bulk of the most qualified staff in order to retain one highly ineffective administrator and to protect itself from what it felt was an impending law suit by the employees. It hunkered down and stonewalled all efforts of Baker County citizens to hold it responsible.

Baker County Commission Level.

Per Oregon Administrative Rules, the Baker County Board of Commissioners (Commission) decides what organization will provide mental health services in Baker County. Presently, and for over two decades, Baker County has contracted with MVMH to provide those services with an automatic renewal clause in the contract.

One of MVMH’s board members, Dr. Carl Stiff, is also a Baker County commissioner. There is an inherent conflict of interest in serving on both the Commission and the Board. Originally the County Commission no doubt thought he could be a liaison between the Commission and the Board. But when the employees brought to light serious problems at MVMH, Commissioner Stiff was precluded, so he said, from saying anything about the matter to the public—and I assume to his colleagues on the Commission—because of confidentiality of employee matters. So, one member of the Commission who should have been representing the citizens of Baker County by providing oversight over a $1,000,000 plus operation was effectively muzzled concerning the serious breakdown that had happened at MVMH. As far as I know, he remains muzzled to this day and ineffective in his role as part of oversight of the MVMH program.

Member of the MVMH Board, Barbara Warner, is the step-mother of County Commission Chair Fred Warner, Jr. I feel that Commissioner Warner has acted fairly in addressing MVMH problems that have recently been brought to the Commission’s attention. However, there is an appearance of impropriety, when a relative of a member of the Commission is on the board of a program that must seek the Commission’s approval for a contract to provide mental health services in Baker County. This apparent conflict begs the question, why, given a wealth of qualified persons in Baker County, did the Board appoint a relative of a commissioner?

Per Oregon Administrative Rules, the Commission is required to appoint a director of mental health programs for Baker County. Yet it appears that the Commission was unaware that such an appointment was necessary.

Per Oregon Administrative Rules, the Commission is required to appoint a Mental Health and Developmentally Disabled Advisory Committee to advise the Commission and the director of mental health programs. Last August I asked the Commission for a list of the members of the advisory committee. The Commission was unable to confirm that such a committee existed. In fact it didn’t exist and Commission Chair Warner admitted that he was unaware of the Commission’s duty to appoint such a committee. To the Commission’s credit, as soon as the Commission determined there was no mental health and developmentally disabled advisory committee in existence, it immediately advertised for interested parties to apply for appointment. And last November the commission appointed a ten-member committee.

In spite of the fact that the Commission has the responsibility to oversee the operations of MVMH, the Commission apparently failed to review the findings of the 2003 State and GOBHI site reviews or to make sure MVMH had complied with all required corrective actions before renewing the County’s contract with MVMH. Without such a review the Commission cannot possibly make an informed decision about contract renewal.

GOBHI level.

GOBHI provides a level of oversight of MVMH intermediate between County and State. Among other things, GOBHI receives required monthly statistical reports from MVMH to insure ongoing adequate levels of service and conducts site reviews every two years. However, until December 2006, it had not conducted a site review of MVMH for over three years.

Following the last site review three years ago, GOBHI sent MVMH a report of its assessment of the program. That report found that 46% of the policies and procedures were entirely missing and 26% were either incomplete or out of date. The report required that MVMH submit, within certain narrow time limits, an action plan directed toward improving a number of deficiencies uncovered during the site review. It appears that MVMH never submitted the plan and that GOBHI never followed up on MVMH’s lack of compliance. Follow up is important, because some of the deficiencies concerned licensure and having certified persons in the crisis management rotation. MVMH continued putting unqualified staff in charge of handling crisis intervention, which at times deals with life and death issues.

There is also conflict of interest at this level. The director of GOBHI is Kevin Campbell. He is the head of an agency that monitors the activities of MVMH, which, until recently, had been administered by Tim Mahoney. In their private lives, Director Campbell and Mahoney are business partners. In May of last year they purchased a laundromat in La Grande. When one partner of a private business supervises the other in their employment relationship as administrators of two semi-public agencies, this private business partnership, at the very least, presents a clear appearance of impropriety.

The composition of the GOBHI board of directors also presents an inherent conflict of interest. A good portion of the GOBHI board of directors consists of directors of programs over which GOBHI has oversight. That board hires the director of GOBHI. This means that Director Campbell is monitoring the operations of the persons who hired him.

State level.

The Department of Human Resources exercises oversight of MVMH to make sure that it follows State and Federal regulations in its provision of mental health services in Baker County. As a result of the site review three years ago, the State required that MVMH submit an action plan to correct certain deficiencies discovered in the site review. MVMH submitted an action plan to the State but failed to implement portions of the action plan. The State admits that it failed to make sure the 2003 action plan was fully implemented. As a consequence of that lack of follow-through, the State’s most recent site review found the old issues unaddressed, plus many more serious deficiencies in the operations of MVMH.

The format of State site reviews is partially at fault for the mismanagement that has been going on for years at MVMH. The fact that site reviews have failed to correct many long-standing serious problems would give credence to this belief. The first problem with the format concerns review of case files. The State cannot possibly review all of MVMH’s case files, so it selects a small number of files and notifies MVMH days in advance which files the State will review. That leaves the door open to fixing of deficiencies in those few files before the site review team arrives, thereby giving the State a false impression of the overall operation. Second, during the site review the State does not interview employees individually but rather in a group, an environment not conducive to eliciting candid remarks, especially if employees are working for a boss who they feel will make them pay for any criticism of the administration. And third, the State has not been in the practice of interviewing former employees or former clients from whom the State is more likely to receive candid comments.


MVMH deals with some of Baker County’s most vulnerable citizens. They need someone to advocate for them. I encourage all concerned citizens to make their views known to Baker County Commissioners Fred Warner, Tim Kerns, and Carl Stiff.

Gary Dielman

No comments: