Mental Health Chief in Battle Over Spending of State Funds

Roberto Quiroz, the county’s recently appointed mental health director, probably would have been a lot better off if his department had not received more than $20 million in new state funds this year.

Without that money--the first real bonus county mental health programs have received in years--the odds are good that Quiroz could have quietly established himself in his new job and mapped out his plans for the highly visible department.

But largely because of that money, Quiroz has been fighting a multifront battle over how best to spend it. He has been accused of being in the pocket of county Supervisor Michael Antonovich’s health deputy, Marcia Nay. And he has had to struggle for months to establish credibility with community groups that ordinarily should be among his strongest allies.

At the core of the fight is how Quiroz sought in two separate actions to pump millions of dollars of new state money into Antonovich’s pet project, Olive View Medical Center, at the expense of community-based, non-hospital programs backed by private mental health advocates. If that were not enough conflict, Quiroz also finds himself on the sticky fringes of a political squabble between his controversial predecessor, Dr. J. Richard Elpers, and Nay over Elpers’ hiring nearly a year ago by the UCLA School of Medicine.

With a $210-million budget, the largest in the state for a local mental health program, Quiroz oversees a wide array of services ranging from emergency medical treatment of the mentally ill at county hospitals to neighborhood crisis intervention centers where people can get emergency counseling. The county’s mentally ill population runs the socioeconomic spectrum and includes all age groups.

The fundamental battle lines surrounding Quiroz are formed by two groups. On one side are proponents of community-based, non-hospital treatment of the county’s mentally ill. On the other are backers of an increase in emergency hospital beds to deal with, among other conditions, the rising number of homeless mentally ill.

Quiroz, whose background is in social work, has been with the county since 1979, when he left a mental health center directorship in Pueblo, Colo., to become the department’s regional director in the San Fernando Valley. Early last year, Elpers promoted him to head of departmental planning, and when Elpers resigned to take the UCLA post, Quiroz was named acting director last Sept. 4.

Caught between two seemingly opposite approaches to mental health care, Quiroz, 47, has been on the defensive almost from the day last March when he was named permanent director. For months he has been waging a one-man public relations fight to persuade these competing constituencies of the merits of his plans for the Mental Health Department and insisting that he supports all of their goals.

“Our whole focus is not (just) emergency services,” Quiroz said. “What we’re trying to do is a balanced system of care. But a balanced system of care includes inpatient care and it includes community-based care and it includes self-help and a whole range of programs.”

Despite these assurances, Quiroz’s main credibility battle has been with private mental health providers, family groups and volunteer mental health organizations that have sharply criticized some of his actions.

They say Quiroz betrayed them when he scrapped a comprehensive plan to spend nearly $14 million in new state money on non-hospital programs in favor of a plan heavily weighted toward increasing the number of emergency county hospital beds. While some new emergency beds were justified, these advocates acknowledged in interviews, they complained that Quiroz shortchanged non-hospital community programs.

“We gave our priorities of what we felt was needed,” said Donald Richardson, vice president of the National Alliance for the Mentally Ill, a parent support group. “Then Roberto set those on the shelf and came up with his own plan, which in many cases ignored the plans of (the community groups).” Richardson, also a member of the county’s Mental Health Advisory Board, said the general reaction to Quiroz’s move was one of shock.

Quiroz’s spending plans also triggered immediate accusations from a host of private community organizations and contractors that Nay, Antonovich’s health deputy, had pressured Quiroz to redirect money from the inner city to Antonovich’s San Fernando Valley-area district. Nay said she favors an increase in emergency hospital beds to serve the homeless mentally ill, but adds that she also has been highly critical of what she views as a lack of mental health funds channeled to Antonovich’s district under Elpers’ administration.

Nay also lobbied hard for Quiroz’s appointment to the $75,000 post.

The suspicion surrounding Nay and Quiroz grew out of departmental proposals to pump millions of dollars into the soon-to-be-opened Olive View Medical Center, a pet project of Antonovich’s. The new facility, near completion on the same site in Sylmar where its predecessor was destroyed by the Feb. 9, 1971 earthquake, is scheduled to open in January.

Vetoed by Governor

Quiroz had called for Olive View to receive nearly $3 million in state reimbursement early next year in exchange for a county takeover of the care of some patients who were in state mental hospitals.

Quiroz’s proposal for Olive View was criticized by Kenneth Carhill, a state Department of Mental Health deputy who said in an interview that the county plan would not reduce the number of patients in state mental hospitals. But before the state and county could negotiate the issue, Gov. George Deukmejian vetoed the appropriation.

Another objection to the Quiroz plan came from state Sen. Bill Greene (D-Los Angeles). He introduced special budget language to block it, contending that Quiroz was trying to shift money from his South-Central Los Angeles inner-city area to the San Fernando Valley suburbs represented by Antonovich.

Undeterred by the Deukmejian veto, Quiroz soon found another source of funds for Olive View. Without consulting the community groups, he proposed that the $3 million come instead from new state money that the community groups had counted on for non-hospital programs. Quiroz proposed that the money be used for inpatient services at the new facility.

Community groups protested the move, which had refueled suspicions that Antonovich’s aide, Nay, was calling the shots in the county Mental Health Department. After the community groups protested, Quiroz reduced the amount earmarked for Olive View by $1.1 million.

Health deputies for other county supervisors say they joined Nay in urging Quiroz to fund new hospital beds, particularly for the county’s homeless and child abuse victims. But Nay--more than any other person, including Quiroz--has become the focal point for the anger and suspicion of the department’s critics. And the reason cited most for the suspicion is Olive View.

Defends Increase in Beds

Both Nay and Quiroz, in separate interviews, deny that Antonovich’s office is exerting any improper influence on the mental health director or the department’s programs.

Nay acknowledged that there have been complaints, but laughed when asked if she controls Quiroz. “I don’t think so. He doesn’t do everything I want,” she said. “I think he’s controlled by Roberto. If you’re wrong, he’ll say you’re wrong. . . . He’s not afraid to do that.”

Quiroz, asked the same question, responded: “No. It’s very hard to deal with issues that are value-laden. There are people who have perceptions and will have those perceptions regardless of what happens.”

Quiroz also denies charges by community groups that he has not been independent enough and that the department has become too politicized since he assumed the directorship.

“We want more funding for our mental health system and yet we criticize the politics that go with the job,” Quiroz said. “Frankly, I think there’s been a lot of misunderstanding and miscommunication as to what some of our goals and our objectives have been about.”

As for Olive View, Quiroz said the money that has been proposed for the new facility is justified and would provide emergency hospital care for countywide patients, not just those in Antonovich’s district. Quiroz also defended plans to expand the number of emergency hospital beds in the county, arguing that such services are part of a full spectrum of mental health programs.

In addition to the funding disputes, Quiroz is on the fringes of a politically sensitive dispute involving Nay and Quiroz’s former boss--and longtime Nay nemesis--Dr. Elpers. Nay, who admits that she did not get along with Elpers, had urged both county Chief Administrative Officer James C. Hankla and the UCLA School of Medicine to investigate whether UCLA had improperly hired Elpers last year as a professor of psychiatry.

Both agencies concluded that there were no improprieties, but the dispute has stalled a mental health teaching contract between the university and two county teaching hospitals for several months.

Although county sources say Nay was the only person to raise the question about Elpers’ hiring, Nay denies it. She said unnamed county employees had alerted her to a possible conflict and that she felt the questions about Elpers, who would be a recipient of a small amount of the county contract money, were appropriate for an investigation.

“This was not the 5th District single-handedly leading the charge,” Nay insisted.

Quiroz refused to comment on the probe of Elpers, referring questions to the Department of Health Services, which administers the contract.

‘Cutting His Eyeteeth’

The conflicts have put Quiroz at a political turning point in the young administration of the department. In sizing up his performance so far, both supporters and critics express a mixture of sympathy and admiration for his ability to withstand the competing pressures.

Linda Faber, chairman of the Mental Health Advisory Board, said that Quiroz is “cutting his eye teeth” and “tries to please too many people and gets caught in the squeeze.” An Antonovich appointee to the board, Faber added that Quiroz is doing a good job of demanding that the mental health community re-examine the effectiveness of various programs.

Even his toughest critics, however, feel that Quiroz is a victim of political and financial circumstances outside his control and are not calling for his removal.

“I think Roberto’s in a no-win situation,” said one mental health provider who insisted on anonymity, “It doesn’t help the mental health system if we go after him. They’ll wind up kicking him out and getting someone else.”

One self-described convert to the Quiroz camp, John McDonough, a veteran member of the county’s Mental Health Advisory Board, said he is convinced that Quiroz will be a good director.

But McDonough added the caveat: “One of the challenges he faces is, he’s got a responsibility to the mental health community that the ground that has been gained by the department and its ability to be master of its own destiny does not get lost.”

Asked for his own assessment of his tumultuous first months, Quiroz shrugs a barely perceptible shrug and offers an unbureaucratic response:

“It’s a tough gig.”