County’s Mental Health Chief Weathers Storm : Wachter-Poynor Defends Her Role as Problems Continue to Plague System

As San Diego’s public mental health system has veered from crisis to crisis during the past several years, with wholesale changes in programs and administrators, there has been one constant: the system’s leader.

Kathy Wachter-Poynor, who rose through the ranks to become the county’s mental health director in 1980, has survived in that post even as the county has admitted shortcomings in patient care, long-range planning and personnel matters.

But in the last several months, with new problems continuing to plague the mental health system, a widening group of people associated with mental health--including mental health professionals and advocates for the mentally ill--is growing increasingly impatient with Wachter-Poynor’s leadership. Some have called for her resignation or firing.

Wachter-Poynor and others in mental-health administration defend her role, saying she has done the best she can, given the lack of money and attention devoted to the department by the Board of Supervisors and the public. Pointing the finger at the director only satisfies the need for a scapegoat without addressing the larger issues, her defenders say.

The first major crisis occurred two years ago when the county acknowledged that its Hillcrest psychiatric hospital, which is under her control, was in shambles, and the state nearly closed the facility out of fear for the patients’ health and safety.

Now, 18 months after Wachter-Poynor and her staff began a crash effort to turn the Hillcrest hospital’s fortunes around, there are signs of neglect in other segments of the far-flung, $50-million-a-year system designed to ensure adequate care for mentally ill San Diegans too poor to afford private counseling or hospitalization.

While the county system includes many of the elements needed to provide that care, leadership at the top--planning for new programs and reviewing the effectiveness of current services--is weak, many believe. And Wachter-Poynor at some point must be held responsible for that weakness, they say.

“If an executive comes to the point where their subordinates lose confidence in their competence and don’t recognize them as a leader who can make things happen, and the world at large, the public, the social agencies, the mental health professionals, if they lose confidence in the leadership, then I think that person has to go,” said Bob Haack, president of the San Diego chapter of the California Alliance for the Mentally Ill. “I personally feel very strongly that Kathy is in that position.

“I think it’s time to make it happen,” he said. “There’s no honeymoon for the people who are mentally ill. There’s no honeymoon for the parents who support them. Why should we give a honeymoon for the people who run the system? I don’t think they deserve that time. I think the time has run out.”

The major criticism of Wachter-Poynor is that too often she reacts to crises rather than detecting problems in their early stages and solving them.

“A crisis will happen and then Kathy will come up with some kind of solution she will propose to take care of whatever has been the crisis,” said Dr. Jay Shaffer, former chairman of the county’s Mental Health Advisory Board. “What she doesn’t seem to do is say, ‘We have a serious problem here and this is what we’re doing about it.’ She always seems to be in a defensive, reactive position.”

Another former chairman of the board, San Luis Rey Hospital administrator Bill Sparrow, holds a similar view:

“There appears to be no main strong mental health person leading the department,” he said. “Everything CMH (county mental health) does is react. They almost never lead. They always react to tragedy and problems, often too late.”

Critics point to several examples to buttress their charges of administrative disarray:

- In 1984, complaints from county employees prompted Wachter-Poynor and her superiors to request a district attorney’s investigation into charges of drug-dealing, prostitution and high-stakes gambling at the Hillcrest hospital. The investigation failed to find evidence to support those allegations but Dist. Atty. Edwin Miller said he found “appalling” screening practices that allowed convicted felons to gain temporary jobs at the hospital.

- In 1985, complaints from employees again led to investigations, this time into patient care and administration at the hospital. A probe by the state Department of Mental Health concluded that two deaths at Hillcrest could have been prevented and harshly criticized the hospital’s staffing, administration and record-keeping. Families of several former Hillcrest patients contended that their kin committed suicide shortly after being discharged from the facility.

- The county grand jury in June, 1985, found that the Hillcrest hospital suffered from an unclear chain of command, lax supervision and poor record-keeping and that doctors refused to accept patients who belonged at the hospital and failed to care properly for those who were there. Criticism from the grand jury and others led to the transfer of Hillcrest’s medical director, the retirement of the director of health services and the forced resignation of Clifford Graves, the county’s former chief administrative officer.

- Dr. Thomas Henley, hired in July, 1985, as interim medical director at Hillcrest, quit the post a month later, citing frustration over the county’s inability to recruit qualified psychiatrists to work at the hospital. Another doctor, Clyde Martin of the California Medical Facility at Vacaville--under the state Department of Corrections--took the job in May, 1986, but then decided in July not to come, citing “personal reasons.”

Still unable to fill the job--a spokesman said that Hillcrest has been unable to recruit the desired candidate who has an academic background--Wachter-Poynor has used her clinical director, Dr. Harold Mavritte, as medical director at Hillcrest for the past 15 months. That has taken Mavritte away from his key position as the only doctor overseeing the county’s mental health system.

- The U.S. government in February revoked Hillcrest’s right to receive reimbursement from the federal Medicare program. The action came after a review of treatment of 21 patients during an 18-month period revealed violations of federal regulations that held a “potential for serious patient harm.”

- Attempting to improve care at Hillcrest in 1985, the county abruptly eliminated 32 of the hospital’s 92 beds, under the theory that it was better to provide good care for fewer patients than substandard care for a greater number of people. This decision led other providers of mental health care to complain that the impoverished mentally ill were being shuffled among hospitals and, at times, turned out on the streets with little or no treatment.

- Critics say the county has been slow to eliminate a serious shortage of case managers, known as the “glue” that holds the public mental health system together. Case managers are responsible for interviewing patients when they leave a county clinic or hospital and ensuring that they get continued attention, in the hope of reducing the likelihood that they will be hospitalized again.

- Unable to spend $3.3 million in state funds because of administrative delays, the mental health division postponed for nearly a year implementation of programs to help the homeless mentally ill. It also postponed a companion program to reimburse board and care homes that take in particularly troublesome patients.

It was this failure to spend state money promptly that set off a new wave of criticism of the mental health administration, because the county has long contended that its shortcomings were the result of inadequate funding from the state.

“What they’ve done for years--and they’re still doing it--is they’ve always excused everything on the fact that they don’t have enough money,” said Helen Teisher, a member of the Mental Health Advisory Board and longtime advocate for the mentally ill. “Now how can they excuse the fact that they haven’t been spending all the money they do have?”

The Mental Health Advisory Board, created under state law to give the public a chance to advise county officials on mental health issues, was asked by one of its members Dec. 3 to vote “no confidence” in Wachter-Poynor’s leadership. But the board instead referred the matter to its executive committee, heeding a request from county administrators who did not want the subject discussed in public.

Shaffer, Sparrow and another former chairman of the advisory board, psychologist Jay Dess, hope to share their concerns about the department’s administration with the newly appointed director of the Department of Health Services, Dr. J. William Cox, who has said he will evaluate every division in the department after he takes over in January.

Cox has declined comment on specifics of any aspect of the department. Norman Hickey, the county’s chief administrative officer, also declined comment on Wachter-Poynor’s performance.

In an interview with The Times, Wachter-Poynor said she has no plans to quit. She said she believes her division is performing as well as could be expected with the limited funds available in San Diego for mental health services.

“There are an awful lot of people in the community frustrated because the mental health system just isn’t able to meet the needs of the people of San Diego County,” she said. “It’s logical for them to want to blame somebody. It’s logical for them to want to blame the local mental health director. But that doesn’t mean because people want to finger the local mental health director that . . . what they’re saying is the total picture.

“I have to answer to my boss. My boss is (Chief Administrative Officer Hickey) and the Board of Supervisors. I also have to answer to my management team and, most importantly, to myself. And as long as I know that I’m doing my very best I will continue to remain as deputy director for mental health until my appointing authority decides otherwise.”

Betty Snyder, executive director of the San Diego Mental Health Assn., an advocacy group for the mentally ill, pointed the finger at county political leaders for not providing consistent funding.

“She (Wachter-Poynor) needed backing from the Board of Supervisors, needed more money,” Snyder said. “Being head of the thing, she is ultimately responsible. But I don’t think she went out there by herself and said, ‘OK, we’re going to let this thing slide down the tubes.’ ”

Mavritte, the clinical director, said that financial neglect over many years has taken its toll, forcing top staffers to spend time on administrative matters normally handled by mid-level managers. He said that no director could have coped with all the problems caused by the lack of money.

A graduate of Fresno State University and the University of Hawaii, where she earned a masters’ degree in public health, Wachter-Poynor came to the county as a health educator in 1970. Wachter-Poynor, 39, has never held a full-time job in the health field outside of her work with San Diego County.

In her health educator position, she helped set up special projects and programs aimed at assisting troubled individuals before they needed the costly services of public psychiatrists. Over the next decade, she moved up the administrative ladder, becoming chief of community services in 1978 and director of mental health in 1980, with an annual salary of $65,270.

A friendly woman with a warm, open personality, Wachter-Poynor is well liked by her employees and others throughout county government. Those who know her well believe she is deeply committed to helping the mentally ill. The San Diego Mental Health Assn. earlier this year gave her an award for “leadership through the CMH crisis.” But that personal affection for her does not always extend into respect for her performance atop the 750-employee mental health bureaucracy.

Because she is not a physician and lacked hands-on experience running a mental health program of her own before becoming director--rare among mental health directors in California--Wachter-Poynor’s critics question whether she understands the needs of the patients and those in the public and private sector who provide their care.

“I wonder sometimes if Kathy has spent enough time with the people,” said Teisher, whose 37-year-old son is mentally ill. “Does she know what chronic mental illness looks like? Does she visit board and care homes? Does she spend enough time at (Hillcrest)?”

Shaffer added: “If you have somebody in leadership who is clinically aware and concerned, they can create a pretty good program with limited resources . . . Someone who has a track record of managing clinical services, somebody who would take the the major sources of referrals to (Hillcrest) and realize those sources could be educated to use other resources. Someone who could get together with the police, the Sheriff’s Department and set up training for people on the street. You need someone who is going to facilitate that kind of interaction.”

A few county officials say privately that the department could benefit from new leadership.

“My sense is it is time for a new leader to come in and say enough is enough,” said a county official who aasked not to be identified. “I think we need a real strong person to head up the mental health system. Only a new person would be able to do that. I think Kathy is too entrenched with the problems that exist and is carrying too much baggage from the problems that did exist.

“We can’t just validate the system that’s there now. A new person goes to the very basis of the principles the system is in place for and instead of validating that, they reevaluate them and make recommendations to improve the program.”

But Wachter-Poynor insists that her staff is capable of just such an objective review and is in fact completing one.

“What we’re doing is setting up a system of priorities of what we could do and how much money we need to do it,” she said. “If the money grows, we can go further down the list. If the money shrinks, we’ll have to cut back in order to do what we do well . . .

“With the limited amount of state and county funding we get in this county for mental health, there are a lot of services that don’t exist or are funded inadequately,” she said. “Unfortunately, I think the mental health system in San Diego County has tried to be all things to all people, and you can’t be, not with the resources we have. We’ve reached a point in time where we have to set priorities.”