Mental Health Crisis Blame Laid to County

With Los Angeles County on the verge of closing a third of its mental health outpatient clinics, community protesters and local officials alike have portrayed the state as the villain in a deepening mental health care crisis.

But former and present employees of the county Department of Mental Health as well as some members of the agency’s citizens advisory committees claim director Roberto Quiroz and his bosses--members of the Board of Supervisors--must shoulder much of the blame for the department’s troubles. Poor management, as well as a lack of state funds, these critics maintain, are the reasons why eight mental health centers are scheduled to close and services at eight other facilities are to be curtailed.

Attorneys for indigent, mentally ill patients will go to court on Monday to try to prevent the county from shutting those outpatient clinics and forcing 20,000 mentally ill patients--many of whom are poor--to use more distant clinics or crowded emergency hospital rooms or go without medical treatment.

Citing a budget squeeze, mental health officials contend the cuts are necessary because of the lack of state funding, but critics contend that the crisis has been exacerbated by a mental health department that, under Quiroz, has lacked controls over its budget and has squandered money earmarked for the mentally ill.

Departmental correspondence, internal reports from the Chief Administrative Office and an audit by the county auditor-controller over the last two years, which were obtained by The Times, show that the agency was warned at various times about exceeding budget appropriations, failing to monitor programs closely and losing track of some of its expenditures.

But Quiroz and his supporters, which include members of the mental health community and county supervisors, defend his administrative record. And Quiroz himself said many of the problems identified in audits and other reports have been corrected.

“I think we have done everything we can to keep this system afloat,” Quiroz said.

But criticism persists.

“There’s no way to know if there is a genuine (budget) crisis,” said Roger Rice, who was a division chief of the department’s program review and evaluation division until he retired last March.

“There’s a good possibility that the money is there in the department to save the clinics but everything is in such disarray, they don’t know where it is,” said Rice, who also served as a departmental consultant until he ended that job last month.

Gerard Gumbleton, a member of one of the department’s service advisory boards--or citizens advocacy groups--agreed and said that he and other committee members had warned the Board of Supervisors last year that the mental health department under Quiroz was “management in chaos.”

“We petitioned the board to hold public meetings but they wouldn’t do it,” Gumbleton said. “We didn’t think then that the money was being used judiciously, and we still don’t think it is.”

Those rebukes of Quiroz and his department were echoed in interviews with three dozen present and former department employees and mental health contractors--most of whom spoke on the condition they would not be named. And the criticisms come at a time when the mental health community has struggled to maintain a united front to lobby legislators and Gov. George Deukmejian for more money for mental health care.

Quiroz said he believes the criticism against him stems from opponents of his attempts to overhaul the county’s mental health system--including consolidating programs and eliminating some outpatient clinics.

“The time calls for honesty, and with the limited resources we have, we just can’t have the proliferation of clinics,” Quiroz said.

“When my critics say we need more monitoring, more program review and more fiscal control, I agree with them, but the real question is you can’t do it on a limited budget,” he said.

Just how strapped the mental health budget is and just how sizable a deficit the department faces if it does not close the outpatient clinics are subjects of sharp difference, reflected even in Quiroz’ own estimates to county supervisors.

Last July, during budget deliberations, he told the board that his department faced an $18.7-million deficit unless the clinics were closed. After the supervisors threw in $1.5 million to extend four outpatient programs, the department still put the deficit at more than $18.1 million. And last week, Quiroz surprised supervisors when he told them that $24 million is needed to restore the threatened clinics.

To his critics, that type of fluctuation represented just how uncertain Quiroz and his staff are about the scope of the mental health crisis and what is needed to handle it. But Quiroz said that the changing numbers reflected the cost of running the various clinics beyond the original July 1 curtailment date as well as other mounting financial costs.

Quiroz said the state--which funds 90% of the mental health programs--has not given the department or county mental health contractors a cost-of-living increase for the last two years and has not raised the basic funding to counties. The result, he said, has been an inevitable financial crunch as money for one-year programs came to an end.

But critics also say a series of reorganization plans and a lack of administrative controls have hampered the department.

They cite an internal memo from the department’s chief financial officer to Quiroz last August that says the auditor-controller discovered $4.5 million in commitments beyond the amount that the board appropriated for the department. Although Quiroz questioned that figure, his own financial officer cited the lack of internal controls over spending, pressure by the board to “get contracts” done and an overtaxed accounting staff as possible reasons for the discrepancy.

Quiroz said the department has overcome those problems as well as problems identified in an audit released earlier this year that said the department needed to improve its fiscal controls. Another letter from the Chief Administrative Office in January, 1987, had also expressed concerns and imposed tighter controls on its spending.

Some of those who defend Quiroz say he is an untenable position as the head of a beleaguered mental health system that is woefully short of funding. But critics like Dr. Rodolfo Garcia, a deputy director who now works as a staff psychiatrist at Harbor-UCLA Medical Center, claim Quiroz has crippled the system.

“There are reasons to believe the . . . shortfall is a ploy to bring more money into the system to be unfairly distributed,” he said. “The shortfall is an attempt to cover up the tremendous waste of scarce state dollars that chronically mentally ill patients have been deprived of.”

Among the firms that Garcia named as a favored recipient of departmental dollars is the Telecare Corp., an Oakland-based firm that has won major contracts with the department without competitive bids. Those sole-source contracts, which county rules permit, have enabled the company to operate a 136-bed facility in Paramount and a 100-bed center in Norwalk. Telecare Corp. also is in line to receive a $2.4-million contract for a facility in East Los Angeles to care for mentally disturbed children.

Quiroz defended the selection of the firm because of its experience in the mental health field. “On the basis of any standard that’s reasonable, our record is unimpeachable,” said Anne Bakar, president and chief executive officer of Telecare.