Behavioral Health Agency Under Fire

Ventura County’s troubled Behavioral Health Department is again at the center of controversy with its refusal to treat a mentally ill teenager sentenced to a Camarillo work program.

Superior Court Judge John Dobroth will hold a hearing today to outline the department’s failure to provide care for the juvenile offender. Dobroth has threatened to order treatment if the county does not do so voluntarily.

After hashing out the issue in closed session, the Board of Supervisors last week instructed County Executive Officer Johnny Johnston to appear before Dobroth and assure the judge that treatment will be provided--and that broader changes are underway.

“We will take care of this,” Johnston said. “The last thing we want is a fight with the bench.”

At the supervisors’ meeting on April 16, Johnston will recommend separating Behavioral Health from the larger Health Care Agency, a move officials acknowledge would make it easier to focus on administrative tasks and establish clearer lines of authority.

“That would help expose the problems we have and make it easier to fix them,” Supervisor John Flynn said.

The standoff is the latest evidence of the county Behavioral Health Department’s free fall in recent years. Once held up as a national model for interagency cooperation, the department has seen squabbling and turf wars reduce it to a cautionary tale for mental health administrators across the state, officials say.

“Ventura showed everyone else how to run a model agency,” said Dr. Sandra Naylor Goodwin, executive director of the California Institute of Mental Health in Sacramento. “Now we’re not sure what they’re doing.”

Behavioral Health chief David Gudeman defended his department and his tenure as its leader. He said his department has treated more people on fewer dollars--and has done it at a higher level of quality--than his predecessors.

The problem is that he is being asked to further expand services for incarcerated youths, Gudeman said, with no extra funding.

“I don’t particularly like to feud, but I think there are real issues that need to be resolved,” he said. “I can’t treat all these kids myself. I need money to hire people to go do what I can’t do without money.”

Gudeman’s boss, Health Care Agency Director Pierre Durand, was on vacation and unavailable for comment.

Critics charge that Gudeman, a UCLA-trained psychiatrist, lacks the skills to run a large government agency.

Appointed by supervisors three years ago with little administrative experience, Gudeman finds reasons why his department should not provide services instead of finding ways to make the most of his $50-million budget, detractors say.

He has feuded with Cal Remington, the county’s probation chief, over which department should pay for mental health services. Behavioral Health is also weighed down by internal politics and byzantine regulations on how money can be used, critics say.

Even Gudeman’s staunchest supporters on the Board of Supervisors are voicing alarm at the continuing problems.

“He’s extremely cautious and protective of funding streams and making sure everything is done correctly,” said Supervisor Judy Mikels. “But it’s time to make the laws and rules work for us and not against us. If we’re not willing to make the effort as servants of the public, then we ought not to be in the job.”

The latest flare-up came last month after the Behavioral Health Department refused to treat a teenage boy who had been sentenced to a work program in Camarillo. County lawyers argued in court that Behavioral Health psychiatrists were not contractually obligated to drive the 13 miles from their Ventura offices to the Camarillo site.

That drew a sharp response from Dobroth at a March 27 hearing.

“Basically you’re saying these psychiatrists don’t make house calls,” the judge said. “If we’re all in this together for these kids, what’s the bloody harm in having a doctor drive out there?”

Dobroth then threatened to issue a court order requiring the treatment. He scheduled today’s hearing to present his findings and possibly issue a written order.

Johnston said he hopes to persuade Dobroth that a legal fight is not necessary. The Probation Agency has agreed to drive the youth offenders to the psychiatrists’ office, if necessary, he said.

Also, Gudeman intends to expand a psychiatric residency program, which would make more doctors-in-training available to treat youths at Juvenile Hall and the Camarillo work program.

“Our position has always been that this is a significant program expansion and we want to make sure we have adequate resources to do it right,” Gudeman said.

Johnston said the larger problems are also being addressed. Supervisors have told him to look at every option, from pushing for more flexibility in how they spend money to reviewing Gudeman’s performance.

The department’s troubles began four years ago when an attempt by the Board of Supervisors to merge the mental health department and social services agency sparked a bureaucratic war.

Supervisors rescinded the action within a year, after it became clear that the merger ran afoul of federal regulations. But the snit indirectly led to a federal Medicare investigation that uncovered improper billings and cost the county $15.3 million in penalties.

Behavioral Health chief Steve Kaplan was ousted, and Gudeman, who opposed the merger, was appointed as his replacement. Bitterness among opposing camps on the merger issue lingers, officials say.

The billing fiasco is one reason Gudeman is so scrupulous about following rules on how money is used, his supporters say.

But others say Gudeman’s approach to running the 400-employee department contrasts sharply with his predecessors’. Gudeman has appointed other psychiatrists to top positions and takes a physician-directed approach to treating mental illness.

Kaplan took a broader approach, providing clients with teams of doctors, nurses, social workers and educators. They brainstormed ways to address not just the medical problem but other factors contributing to mental health. It was that cooperative effort that brought Ventura County acclamation two decades ago.

Under the leadership of director Randy Feltman, the county’s mental health agency received national attention by working closely with the probation department, social services, schools and others to help children with mental illness.

The cost-saving “systems of care” that they developed have been replicated across the state and nation and expanded to include adults.

That’s why Ventura County’s troubles are so jarring, officials say.

“Considering all of the problems Gudeman has had, one has to dissect that and find out what is causing them,” Flynn said. “We didn’t have these problems four years ago.”