Koester to Lead Health Services Reorganization

Warned that the merger of social and mental health services could result in the loss of millions of dollars, Ventura County supervisors voted Tuesday to put the county’s top administrator in charge of the controversial reorganization.

The decision marks the latest chapter in the short but tumultuous history of the Human Services Agency, which one supervisor has characterized as an exercise in empire building rather than a move to better serve the public--an accusation that others strongly rebut.

Split over whether to postpone or proceed with the launch of the agency while potential problems are studied in detail, supervisors voted 3 to 2 Tuesday to move forward with Chief Administrative Officer Lin Koester temporarily taking on the added role of health care administrator.

The stop-gap measure comes after legal consultant David P. Henninger warned county officials last week that merging the Public Social Services Agency and the Behavioral Health Department--the subject of an intense dispute within county government--could wind up costing millions of dollars if not carried out correctly.

Henninger, who specializes in medical licensing issues, said the merger, which was approved in April by a divided board, could cost even more than a previous financial estimate of $11 million to $15 million if the new agency fails to comply with state licensing laws and Medicare requirements.

Furthermore, he added, it could also lead to revocation of the operating license for Ventura County Medical Center’s mental health wing.

“This is an interim move to attempt to shape up the license issue and other issues that have developed,” said Supervisor John K. Flynn, who supported the merger along with Supervisors Susan Lacey and Kathy Long, and made the motion Tuesday to put Koester in charge of it.

Supervisors Judy Mikels and Frank Schillo, who opposed the merger, voted against Flynn’s motion, arguing that it made more sense to postpone creation of the agency altogether until the legal issues were sorted out.

“The CAO was hired to do a lot of things, none of which was hospital administrator,” Mikels said. “. . . If Mr. Koester is spending eight hours a week overseeing health care issues, that’s eight hours a week he’s not spending overseeing county services.”

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By placing the top man in the county government totem pole in charge of hospital administration, the board majority is hoping to resolve the main legal concern threatening the merger: that all county doctors are no longer working under the same chain of command.

The Behavioral Health Department had previously been part of the Health Care Agency, and both operate under the same medical license held by Ventura County Medical Center.

But now that mental health doctors have been placed under the Human Services Agency, there are concerns that the license may no longer cover behavioral health physicians because they are operating under a different administration.

The temporary move to place Koester in charge of all hospital operations, which will last 60 to 90 days, should take care of those potential problems, County Counsel Jim McBride said.

“What this does is place the CAO in a position where the line of authority is in place to meet the state and federal requirements,” he said.

Critics of the merger disagreed, saying the interim solution will only make matters worse.

“I think the issue should have been postponed,” said Pearl Lieber, a former secretary for the county’s Mental Health Advisory Board. “Further study is very much necessary. But these people are indignant and stubborn. It’s a shame, because there is already quite a stigma when it comes to the mentally ill.”

Proponents of the merger, which creates an agency similar to those already in operation in Riverside County and several other counties, contend that it will lead to a more “team-oriented” approach to treating the mentally ill, with psychiatrists and social service employees working hand in hand.

Opponents contend the team approach will erode the authority of doctors to make medical decisions about their patients and will prevent the county from seeking Medi-Cal reimbursement for patients they treat.

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Moreover, Mikels and other critics of the merger have questioned the true motives behind the decision, arguing that it has more to do with personal squabbling and turf wars among certain bureaucrats and politicians than an intent to improve public services.

“If the license becomes the sticking point, they’re going to have to decide if personality and power are more important than the welfare of our hospital,” Mikels said in a recent interview. “What’s the rush here? I still don’t get it.”

Long said Tuesday that all supervisors have voted the way they have for one reason: because they are trying to do things in a better way.

“I don’t think there’s one board member that’s insensitive, that’s been bought or that is not aware of all the concerns,” she said. “There are other counties that have done this, and they are all operating well.”