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Focus Should Be on Care

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It’s time to restore order to the way Ventura County manages mental health care.

For more than a year, the Systems of Care teamwork approach that has served as a model for 41 other California counties has been undermined and jeopardized. What began as a legitimate difference of philosophy over how to meet the many needs of the mentally ill has devolved into open warfare of power struggles and political payback.

Ventura County’s mentally ill and their families deserve better. So do the county’s taxpayers.

The key issues are money and power. It is alleged that mental health funds are being siphoned off to help balance the budget at Ventura County Medical Center. A bureaucratic merger designed in part to halt that practice backfired by running afoul of federal law, imperiling $15 million in reimbursements.

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A number of audits may help sort out that part of the mess. The U.S. Health Care Financing Administration audited the county hospital and the two units involved in the ill-fated merger--the Behavioral Health Department and the Public Social Services Agency--to determine whether Ventura County violated federal billing rules and should return millions of dollars in Medicare and Medicaid payments. In addition, county Auditor-Controller Thomas O. Mahon is investigating an estimated $1.5-million budget deficit run up during the eight months the agencies were combined.

We hope Mahon’s review will provide some answers--but it would have been far more helpful had he analyzed the likely effects of the merger before the Board of Supervisors approved it last April. A warning from the auditor-controller and another from the county counsel might have inspired the board majority of Susan Lacey, Kathy Long and John Flynn to move more cautiously--although they ignored warnings from the chief administrative officer and from an outside consulting firm.

The other issue, power, will be tougher to resolve. Under the Systems of Care model, each client is treated by a team that includes a psychiatrist, psychologist, nurse, social worker and others, perhaps a probation officer or educator. It’s an expensive approach but one that emphasizes spending money up front with the goal of reducing other county costs, such as jail time and group-home placements.

The merger attempted to move these teams out from under the medical bureaucracy and put it under the social service bureaucracy. That’s when the federal government balked at reimbursing costs under Medicare or Medicaid.

After months of increasingly strident accusations, finger-pointing, threats and now the ousting of some of the county’s top mental health care managers, it clearly is time for a new approach.

We agree with Supervisor Flynn, the swing vote on this issue, that “everyone needs to take a deep breath before acting further.”

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Supervisor Judy Mikels has called for a meeting with the key players from both factions. We urge them to quickly weed out the ego issues and turf disputes and bring the focus back to where it belongs: on providing quality care to those in need, in the most effective and efficient manner possible.

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