El Dorado County Supervisors approved a recommendation to explore alternatives to running the county’s Psychiatric Health Facility. Director of the Health and Human Services Agency Don Ashton recommended the board authorize a “Request for Proposal to invite proposals to operate and manage the county’s PHF,” according to the April 29 board agenda.
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Usually referred to as the PHF (Puff), the 16-bed facility on Spring Street in Placerville has been targeted by complaints of unsafe conditions both for patients and staff. Ashton also pointed out that staff shortages and “excessive overtime” claims are attendant problems for the department. “Staff working 55 to 60 hours a week shouldn’t be the norm,” he said. “We need to be proud of our PHF.”
Statewide, 16 counties operate comparable facilities while “others contract out; some contract to us. It’s a reasonable way to go,” he added.
District 4 Supervisor Ron Briggs asked Ashton for assurance that “you’re not suggesting closure … As a Republican, I believe in government’s responsibility to care for those who can’t care for themselves,” and called the PHF “an integral part of the county.”
Ashton gave that assurance.
Ten of the state’s smaller counties contract for El Dorado County’s short-term in-patient, mental health services on an “as-requested” basis and pay a portion of the facility’s nearly $4.5 million annual operating budget. Funding for the PHF is a combination of Medi-Cal, realignment of state monies, private insurance, revenue from the contracting counties and the local County Medical Services Program. Ashton suggested that “maybe the rates (paid by other counties) are too low. We are charging too little and we will come back to you for more.” And while he reminded that the Request for Proposal was primarily aimed at gathering information, several speakers protested that the action could look too much like an abandonment of the current program.
“We are opposed to contracting with private (firms),” Jere Copeland, executive director of the El Dorado County Employees Association Local No. 1 said. “The timing is premature … You’re just scaring employees. Let’s do other things first within the county. We’re happy to help any way we can.”
Clinical Social Worker Robert Blum, a 14-year veteran of the county mental health division, noted that “regardless of calling the RFP proposal an exploration, people are spinning out of control.” Blum said he is a staff member with some of the “most serious injuries, missing teeth and a broken wrist.” He pointed out that the number of staff on regular duty is not a problem. “It’s the back-up. We can’t be sick or take vacation,” he said.
Asked if he were “king for a day, what would you do?” Blum responded, “I’d hire permanent part-time employees.”
County Mental Health Commissioner Jim Abram noted that as a regular, sometimes daily visitor to the PHF, he has seen improvement at the facility for some years, especially in staff working directly with the “consumers” (a common description in the mental health care field), and “discharge team planning is much better.” Abram, parent of an adult child “consumer,” expressed concern about losing the relationships the facility staff have developed with the families of their clients over the years and suggested that even if the system were privatized or taken over by another agency, “Workers Comp. claims will continue no matter who runs it.” He suggested that the county continue to “explore what additional funding might be available.”
Dr. Robert Price, director of the mental health division, suggested that the county already “has adequate information,” and “I don’t think privatizing it will make it safer … Privates cut corners, pay less and provide less.” Price also cited results of a “full review by Telecare (that) showed great improvement.” Telecare Corporation is a treatment and advocacy company working in the mental health field.
Staff mental health clinical nurse Margaret McKay gave an emotional testimony about the difference between private facilities and the county’s PHF concluding that “what I saw in eight years with a private, I don’t want to see here.”
On the other hand, chief county medical officer Dr. Alicia Paris-Pombo told the board she supports the RFP, saying the “information (would be) good for making decisions.”
District 3 Supervisor Brian Veerkamp moved the item for approval, saying the board has “a fiduciary responsibility to know as much as possible, to know our options.”
Returning to the dollars-and-cents issue, Ashton acknowledged, “Unfortunately it always comes down to money … so we need to find out how to do it better and more cost effectively.”
Whereupon, board chair Norma Santiago responded, “We have to get out of the paradigm that we’ll have to spend a lot of money … Doing nothing has a cost too. What’s happening internally that’s causing staff to leave? Employees need to be confident there’s no decision being made today.”
Chief Administrative Officer Terri Daly cautioned the board, noting that “outsourcing is not a panacea, and I’m not sure this is cost saving.” She said the issues have been researched extensively for the past three years, “and we realize how big this process can be.”
Reached by phone Thursday, Ashton provided information on the revenue that the county receives for treating patients from other counties. In Fiscal Year 2012-2013, it was approximately $532,000. So far in FY 2013-2014, it is about $342,000, he said. The basic rate is $650 per bed per 24-hour period. Compared to other counties, he said it might be on the low side, and he is exploring a rate hike of about $100. Ashton again made it clear that there is no plan or movement to close or stop the PHF programs, and he added that the county would receive the same revenue whether the services remained public or went private.
Veerkamp’s motion passed unanimously 4-0. District 2 Supervisor Ray Nutting was absent.