County to Dismantle Human Services Agency

Threatened with the loss of millions of dollars in federal reimbursements, supervisors voted Tuesday to dismantle Ventura County’s 10-month-old Human Services Agency.

The action came after federal officials warned supervisors that the 1,400-employee superagency was illegal under federal organizational requirements.

When it merged its Public Social Services Agency with the Behavioral Health Department in April, the county became ineligible for annual Medicare and Medicaid reimbursements, which can add up to $15 million a year.

The restructuring plan was unacceptable because it did not show that a direct line of authority still existed between Ventura County Medical Center and doctors at the county’s mental health unit, federal authorities said.

Chief Administrative Officer Lin Koester had placed the “urgency item” on the board’s agenda after federal officials on Monday rejected the county’s third and final restructuring proposal.

Still, Supervisor Susan Lacey, who had spearheaded the merger effort, urged her colleagues to consider keeping the superagency intact but removing the inpatient unit from its care. The county’s hospital would be in charge of that unit, she suggested, and thus comply with federal regulations.

“We could just carve out the IPU [inpatient unit] and put it back in direct line of authority with the hospital,” said Lacey, who was the only supervisor who voted against rescinding the board’s April decision.

Koester, however, said such a move would jeopardize federal funding.

“To try to split the baby at this point would send the wrong message to staff, and clients would be confused,” Koester said. “The prudent and wise thing to do is to reestablish a direct line of control, and to send a clear message to everybody.”

Specifically, the board’s action does the following:

* Reestablishes the county’s Health Care Agency and Behavioral Health Department as they existed before the April 7 vote.

* Authorizes Koester to report back to officials at the Health Care Financing Administration regarding the board’s decision to rescind the merger.

* Directs Koester and his staff to study the possibility of a different sort of merger, which would transfer only non-hospital and nonmedical services to the Human Services Agency. Staff will report its findings to the board in about six months.

Several supervisors said that, even though the merger failed, it had opened up discussion about the “social model” method of treating the mentally ill.

Proponents say a doctor/social worker team approach to treating the mentally ill emphasizes moving the patient toward independent living.

Under the traditional “medical model,” mentally ill patients are often put on medication and placed in an institution, they say.

Supervisor John Flynn, who voted in favor of the merger along with Lacey and Supervisor Kathy Long in April, said the social model was the wave of the future.

“The Camarillo State Hospital was a total medical model and the state closed them down,” Flynn said. “So anyone who says that a social model is unnecessary isn’t thinking very well . . . Mixing social with medical is morally the right thing to do, but financially we have no choice.”

*

Lacey and others sharply criticized federal employees with whom they met in San Francisco before the latest reorganization plan was rejected.

“I very rarely, if ever, take pot shots at government,” Lacey said, “but there is at least one person in San Francisco that the only name for him could be Benny Bureaucrat,” Lacey said.

“They had a lack of understanding of the whole concept,” Long added. “When the question was raised, ‘What is an IPU?’ that startled me.”

Long suggested that Koester and his staff update supervisors on any future merger possibility by February.

But Mikels opted for a slower approach.

“By trying to rush this thing again and have the report back by the mid-year budget, we’ll be back in the same situation we are in today,” she said.

Supervisor Frank Schillo and his colleagues also defended Lacey, whom some have publicly blamed for pushing to get the merger approved too early. Lacey’s critics say the true motives behind the change had more to do with personal squabbling among certain county officials than with an intent to improve services.

“Supervisor Lacey’s intention was a good intention, and I don’t question that at all,” Schillo said. “Now we have a good opportunity to look at this in an orderly fashion.”

Opponents who spoke at the meeting were relieved that the merger would be dismantled. They said the team approach would erode the authority of doctors who make medical decisions about their patients.

Lita Biejo of Moorpark chided the board for going forward with the merger after a consultant warned that it could cost $15 million a year and possibly lead to the revocation of the operating license for the county hospital’s mental health wing.

Biejo, who has raised her adult nephew--a diagnosed schizophrenic--from the time he was 1, has attended every supervisors’ meeting to protest the merger since April.

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Before Tuesday’s vote was cast, Biejo sang, “Have Yourself a Merry Little Christmas,” but she changed some of the lyrics to, “Rescind this merger and let your troubles be out of sight . . . “

Lou Matthews, director of the Alliance of the Mentally Ill in Ventura and a staunch opponent of the merger, also spoke before the board Tuesday. She said doctors should have primary oversight of mental patients.

“Major mental illnesses such as schizophrenia are disorders of the brain. They are medical conditions,” Matthews told the board. “Most of the gains made that allow people to live more normally have been made with advances in medical treatment with newer, more effective medications.

“We want the best possible life for our sons, daughters or other loved ones who suffer major mental illnesses,” she said.