Thursday, March 20, 2008

Debbie Crane highlights how DHHS & Governor's office can SIMPLY IGNORE ANY AND ALL OF YOUR CONCERNS


I cannot submit e mail to Dempsey Benton, Secretary of NC DHHS; Leza Wainwright, Co-Director of NC DHHS's Mental Health Department; or, Mike Lancaster, MD, Co-director of NC DHHS's Mental Health Department.

Neither can I submit one to the main e mail address of the State CFAC (Consumers and Family Advisory Committee: by law, the state must create their functionality).

And, it appears, I can submit concerns night and day to the various LME CFAC committees for all that's worth : I never get a replyl from any of them either.

What, you might ask, did I do in order to be blocked from sending them e mail? Why is there never a response to any of my letters? Why no returned telephone calls?

I have never slandered them; I have never been rude.

I have been extremely vocal in voicing my complaints about how they have failed----with all the details that a provider in-the-trenches----can provide.

I have never received a reply though I have US mailed, telephoned, and e mailed members of the State CFAC committee as well as the local CFAC of Smoky Mountain Center LME in western NC.

NADA No reply nothing
Absolutely no indication that anything has been taken into account,
entertained as a possible solution, or simply dealt with.

The only person in mental health associated with NC DHHS who has EVER responded to me was Mike Moseley, the Director of Mental Health, who just 'retired.'

If, as Ms. Crane states, there is no archiving of e mails, if the governor simply tosses the letters, if government officials are not supposed to create solutions via correspondence w/ concerned citizens----then WHY should we pay their salaries?

If I am not available to my mentally challenged clients, my license is at risk.

How is it that public officials in NC can whistle past every single letter/ e mail/ phone call/ fax?

Marsha V. Hammond, PhD : Clinical Psychologist, Asheville, NC

*************************associated story:

State spokeswoman fired in mental health flap speaks out on public records

".......There should be a clear policy regarding e-mail, something already spelled out in state statutes for anybody with "common sense."

She said public officials should archive e-mails.

Crane said e-mails are public documents no matter what system a government official is using.

There is a feeling among government employees, she said, that personal e-mail carriers are immune from public records laws. "If it's public business it's a public record whether you're using Gmail, Roadrunner or Hotmail," she said.

Other changes she suggested include:

- Making a public records contact person easy to find.

- Changing forms state agencies use so private information can be more easily gleaned from the public. This would speed up the process for receiving documents, Crane said.

- Requiring that those who request a public record get an immediate response that includes an estimate of how long it will take to get the records...."

Tuesday, March 18, 2008

What is the Value of Bear Stearns and what is the value of a person with a chronic, mental health problem?

Efficient Markets Can Value Assets. Ours Can't

“…..And it's really as simple as the difference between $84 and $2 per share. Efficient markets are those that can tell what something is worth. Ours can no longer make that claim, whether in regard to financial stocks or, by extension, about the much larger pool of private debt. The numbers Bear Stearns posted last year, the numbers it clung to until the bubble finally burst, proved in the end not to be worth the recycled paper they were printed on. Just like the mortgage debt that had been rated AAA but ended up at the bottom of the junk pile. Invest in America, where the numbers can be anything you want…..”

There is something eerily reminiscent about that statement above: “Efficient Markets Can Value Assets. Ours Can’t’

Let’s see: where have I heard that before…just an echo of that. OH! That would be North Carolina Mental Health Reform failure----now playing at your local LME and across your county.

Basically, just as the US finds itself in the position of not knowing the value of anything (Bear and Stearns: January, 2007: $171/ share // March, 2008: $2/ share) there is no value put on mental health care because there is no value assessed for people who have serious, chronic mental health challenges. Many things contribute to this tendency:

(1) people with mental illnesses are commonly in poor positions to argue for themselves. (this is akin to a recent observation by someone re: pancreatic cancer and its stuck in the mud morbidity/ mortality rates: no survives to go after Congress for funding re: research or advancing a cure or at least better treatment)

(2) what is provided re: mental health services, specifically, therapy or whatever orientation, is not in an observable form. Its not a pill; its not a manual that can be pulled out and refreshed. It is a visit to the provider. That’s about the sum of the similarity to more physically-mediated health challenges.

(3) People with mental illnesses are not valued in American culture, the ‘can-do’ culture. Quite commonly, they cannot work at the same rate or for the same pay. There are special accommodations that must be created, frequently, for them to do so. Thus, they are the weak members of the herd. In a word, they straggle---and stragglers are eaten or must be defended.

(4) One of the tools for treatment associated w/ NC mental health reform, Community Support Services (CSS) has been manipulated by NC DHHS to the point that it doesn’t work any longer. We’ve been ‘warned’ by NC DHHS that CSS is NOT: handholding. It’s NOT, in terms of the mandated service notes which are a description of what the CSS worker did with the client, doing things with the client. Its orientation is ‘skill building’ but written about, as re: the service notes, and assumably spoken about, in terms of working with the client, as if it were ‘rubber to the road’ actions between the CSS worker (not even a master’s level person) and the client. What NC DHHS is aiming for is an advanced notion of therapy carried outside the clinician’s office (Moe & Chandon champagne) on Budweiser $$.

So, what is the value of the life of someone with a mental health challenge? That really is at the heart of what is taking place re: NC mental health reform and that is the overarching question being asked of US business----and thus of our culture-----at this point in time.

Tuesday, March 04, 2008

Easley wants to rein in 'abusive providers' and circumvent DUE PROCESS : DEVELOPING LAWSUIT AGAINST VALUE OPTIONS

The below was forwarded to a non-confidential host of providers and mental health advocates as pertaining to a solicitation for Medicaid Community Support Services denials by Doug Sea, Senior AttorneyLegal Services of Southern Piedmont 1431 Elizabeth AvenueCharlotte NC 28204Tel. (704) 971-2593Fax (704) 376-8627:

What does this have to do with Governor Easley's solicitation that 'abusive providers' should be reined in?

Those 'abusive providers' instituted Community Support Services (CSS) on the basis of guidelines that were in place when Hooker Odom was Secretary of DHHS and--- THEN---- DHHS decided they would change the criteria of CSS---after the $$ had been spent and after Value Options (VO) determined the services to be 'authorized.'

What criteria changed?

All of a sudden the Endorsed Provider companies were not supposed to have utilized 'high school graduates' who were 'taking clients shopping' or 'children to the swimming pool.' All of a sudden, under Hooker Odom, more than 15 hours/ CSS was NOT OK.

The leaky gauze that Hooker Odom attempted to plant on the rupture, 'after the fact', was an attempt to tackle the hemorhaging of CSS $$, when in fact NC was moving from almost dead last in terms of mental health $$ spent to somewhere in the middle-----and when the PURPOSE of CSS, as outlined in the continuing saga of CSS, and as per NC DHHS 'Attachment D: Service Definitions : Community Support- Adults (MH/SA) shall include the following: (see page 24)

These shall include the following, as clinically indicated:
• Identification of strengths that will aid the individual in his or her recovery, as well as barriers that impede the development of skills necessary for independent functioning in the community
• One-on-one interventions with the recipient, unless a group intervention is deemed more efficacious, to develop interpersonal, relational, and coping skills in the community, including adaptation to home, school, and work environments
• Therapeutic mentoring that directly increases the acquisition of skills needed to accomplish the goals of the Person Centered Plan
• Symptom monitoring
• Medication monitoring, with documented communication to prescribing physician(s)
• Self-management of symptoms
• Direct preventive and therapeutic interventions that will assist with skill building
• Assistance with skill enhancement or acquisition
• Relapse prevention and disease management strategies
• Psychoeducation and training of family, unpaid caregivers, and others who have a legitimate role in addressing the needs identified in the Person Centered Plan

It seems that 'we wanted an improvement of mental health services but not to THAT degree. ....

And 'learning to swim' or 'how to shop for your groceries' has NOTHING to do with tackling the matter of identifying 'barriers to skill development' or 'relapse prevention' as pertaining to isolated mentally ill people who stay in their houses all day and night because they have no transportation or live to far away (in rural western NC) to get anywhere.

My goodness: what do y ou think this is: 'hand holding?'
E mail solicitation from Doug Sea, attny, re: Due Process lawsuit against Value Options:

From: Doug Sea Sent: Friday, February 29, 2008 1:22 Subject: Due process lawsuit against Value OptionsImportance: High

So far the state has not responded to my demand to correct its illegal policy denying Maintenance of services. Other due process violations by value options also are continuing. I am now considering filing a class action lawsuit and need more information about persons who have been harmed to decide whether to pursue this further.

Please ask for client permission and then send me detailed examples of the following due process violations. I need fact summaries, copies of bad notices and other paperwork,and client identifying and contact information documenting these violations: names, contact info, summary of case, supporting documents, willingness to participate in lawsuit, provider name, case manager contact info, services at issue, diagnosis, hardship facts.

I particularly need details on cases where existing services were reduced or terminated by VO AND the family did NOT appeal OR is NOT getting continued services BECAUSE of due process violations by VO and DMA, such as those listed below. But I also want examples of these violations even if the case was appealed and client is still getting services. Here is my list of due process violations:

1. VO calls to case manager prior to issuing written denial to discourage appeal and to encouraging the family to withdraw the request for services
2. CAP-DD annual review “denial” notices from VO that fail to identify service being reduced or terminated,
3. VO notices mailed to family after the effective date of the termination or reduction of services
4. failure of VO notices to state what services VO is willing to approve in alternative to services being reduced or terminated
5. VO reduction of termination of service without showing any change in circumstances or medical improvement since same services previously approved
6. failure of VO and or informal hearing officer to consider evidence outside of the plan of care
7. failure to make med necessity decisions based on indiv facts of case but rather based on “guidelines” about how many hours are provided for this diagnosis or SNAP score
8. Failure of VO and informal hearing officer to consider facts/evidence between date of initial VO decision and date of informal hearing
9. failure of VO and or informal hearing officer to give appropriate weight to the opinion of treating clinician
10. Failure of VO to talk to treating clinicians before making decision
11. Failure to obtain more info or current info when needed before making decision
12. failure of VO to send written notice to the responsible person/guardian even where VO knows the recipient has a guardian
13. failure of VO to give reasons for its decision in the notice
14. failure of VO to provide copies of all records prior to informal hearing upon request

15. VO notices that fail to notify family of right to continued services (maintenance of service or MOS) pending appeal when existing services reduced or terminated, i.e. when request for reauthorization of existing service is denied
16. failure to provide MOS pending appeal because of change in providers OR family who wants to change providers but cant change providers because would lost MOS pending appeal
17. failure to provide MOS where interruption of less than 30 days between end of prior authorization and request to continue the service
18. failure to provide MOS until VO notice sent to family reducing or terminating service plus 11 days
19. Failure to provide MOS until informal hearing decision plus 11 days
20. VO sending a “denial” notice which does not specify right to MOS pending appeal when in fact VO is reducing or terminating existing services
21. failure of informal hearing officer to notify the family in the informal hearing decision of right to MOS if file formal appeal
22. failure to provide MOS pending formal appeal
23. failure to clearly identify in the notice the right to MOS and when it applies
24. failure to allow additional time to appeal and provide MOS until 11 days after proper notice sent to family

Thanks in advance for your prompt help with this. Let me know if questions. Please feel free to forward.

Douglas Sea
Senior Attorney
Legal Services of Southern Piedmont
1431 Elizabeth Avenue
Charlotte NC 28204
Tel. (704) 971-2593
Fax (704) 376-8627

NC's Flailing Governor : Buck-Passer-Fingerpointer-Meister: WHERE IS THE EVIDENCE THAT BENTON KNOWS WHAT HE'S DOING?

Easley has bought hook, line, and sinker Hooker Odom's estimation that the problem is ALL with the providers and is now attempting to shift the blame to the state legislature:

March 4, 2008 posting from:

Raleigh, N.C. — Gov. Mike Easley outlined three areas of the state's mental health-care system on Tuesday that he thinks need immediate reform and said he would push for legislation in the General Assembly's short session, which begins in May."We need dramatic change, and we need it quickly," Easley said…..

"(Department of Health and Human Services) Secretary (Dempsey) Benton doesn't have the control under the current law. That is one of the things I'm going to ask the Legislature to give him," Easley said. "I'm hoping they will be more receptive this time, because if we can't control it, we cannot change it."

"....And then , somebody else will have to accept responsibility for it, and this time, it will have to be the Legislature....."

Easley said the secretary needs more control over local management entities to be able to evaluate, appoint, fire and replace local providers a timely manner, he said.

(in accord with Bill Franklin's consolitation hypothesis)..... Easley also wants to reduce the number – currently there are 25 – so they can be held accountable and so there is a consistent standard of service across the state.

The governor also wants more control given to DHHS to handle the abuses of community support programs.

"The harder problem, though, is getting providers off the program once they are on the program," Easley said. "That's where the secretary needs some real help."Under the Office of Administrative Hearings, Easley said, these providers can appeal and tie up the process for at least six months and still continue to provide services and get paid (godalmighty: you're talking about an appeals process: let's just do away with that)

....."That's OK if you're talking about somebody building a building," Easley said. "But when you're talking about somebody who's providing mental health services to the mentally ill, and they're not doing it right, you need to move immediately and have them removed."

Another proposed fix to combat abuse is to seek differential pay for mental-health care providers, who get paid the same, regardless of the care the type of care they provide. "Differential pay will correct a good number of these abuses as we move forward," Easley said.

(if the state's agenda is to upgrade the level of care vis a vis the qualifications of the provider, then this would be appropriate. However, you can bet your bottom non-reimbursed $$ that the pay will stay the same while the upgrade is demanded)

"The problem with privatization is you a lot of these agencies shut down on Friday afternoon and open back Monday morning, and people get sick and need help over the weekend, so they have no choice but to send them on to state hospitals."

WRONG, Govna: Clinical Coverage Policy No, : 8! Effective March 1, 2008 NC DHHS, Attachment D: Service Definitions : Community Support-Adults : "This service includes providing "first responder" crisis response on a 24/7/3654 basis fo recipients experienceing a crisis." (I'll let my clients know, who call me at 10 pm on Sunday evening and over the weekends, that apparently they can call the local LME instead of me as this is what seems to be stated as the behaviors that are taking place)

If the providers are not doing what they have signed on to do, then call them on it and call up their associated state licensing facility.

Sunday, March 02, 2008

Mental Health Providers don't need any more busy work 'training': THEY NEED TO BE PAID

There's a really big problem with the suggestions that the mental health care-givers 'need more training.' That's why I did my PhD. I'm trained; when will the state recognize that? The NC Psychology Licensing Board gets that. Who is NC DHHS to ignore that agency?

When will the North Carolina Psychological Association enter into the fray? Not a peep from them. I can only assume that they want mental health reform to fail.

I am sitting here this Sunday evening writing several PCP's and psychological assessments (you have to have both! for new clients under NC mental health reform). I am typing over 100 words/ minute or this would take me hours instead of 2 hours/ person,.....not counting the time I spent with the clients taking the information or driving to see them.

Yes, that's a PhD, with 7 years post graduate training, grinding out PCP's with their ridiculously repetitive questions which are supposed to be 'person centered' (except that the person doesn't get what they ask for).

You see, it more or less TAKES a PhD to understand the infinitesimal thinking behind these PCP's----for this kind of mind-numbing writing was part of a clinical psychologist's training------the creation of these kinds of documents: what you're going to do with the client; what's wrong with the client; how the client will meet blah blah percent of a behavior and over a period of time extend that behavior into, well, until they don't need any more services!

Remember: there is no pay for the creation of this time-consuming document. NADA.

Here is an example; the initial part of the Person Centered Plan (PCP) is intended to cover this:

"Personal Dialogue/Interview" includes this repetitious information evidently constructed by NC DHHS people with not enough work to do: (under that header, these are the questions):

**What has happened in my life this past year? (Include exciting, fun things as well as challenges and concerns)

**Long Term Goals: (What are the things I want to accomplish in the next year? What are my hopes/dreams for the future?)

**Strengths: (What am I good at doing? What do people admire about me? What are my talents/gifts?)

**Preferences: What is important TO me: (What are the people/activities/things/places that matter to me in everyday life? What don’t I want in my life?)

**Needs: (What would I change about my life? What is not working in my life? What do I need in order to be an active part of my community? What do I need to be healthy and safe?)

**Supports: What is important TO me? (What do others need to know or do to support me best in relationships, in things I like to do, in work or school and ways to stay healthy and safe?)

Do you think there are some more ways to say the same thing, perhaps?

Think that about covers everything? You'd be wrong.

Then you ask all those questions to a person in the family.

Then the mental health person who does the interview and writes the report answer the same questions.

Then you render the Axis V diagnoses of the DSM and on Axis III the ICD 9 diagnoses.

Then you list the symptoms.

Then, with the newest version of 'Attachment D: Service Definitions: Community Support-Adults (MH/SA) Medical Billable Service', template at your desk, you stick in the buzz words like 'symptom monitoring'; list the 'domains'; 'self management of symptoms'; more talk about strengths; 'therapeutic mentoring' ; 'skill building'; 'assistance with skill enhancement or acquisition';' relapse prevention', etc , etc., etc.

No NC DHHS buzz words, no pass to GO.

No buzz words, you get a letter from the Quality Management person at the LME or the clinical director who indicates you need to go through 'some more training' in order to create the paperwork w/ the buzzwords in the right places.

And you get no authorization and you go back to the PCP and re-create it until you get it right.

Its amazing there are ANY mental health workers left in NC.

What would be my suggestion as a mental health professional with a doctoral degree in clinical psychology, 12 years of professional experience, one internship, one post-doc year, years of experience of creating psychological assessments?

You might start by having some of the well-trained professionals create the form, for starters. I can assure you it would be a honed-down form covering the basics and there would be no busy-work created by non practitioners within NC DHHS.

In a nutshell, the governor took the millions of dollars which was to have been used for the creation of the scaffolding of mental health reform, paid some other bills, hired some cozy consultants for close to a million dollars when the thing was going down the tubes, then said that the former secretary had not been behind mental health reform, which was of course a lie, and then fled to a fallout shelter whilst avoiding the sad parade of perturbed, saddened, and hopping mad, citizens and providers.

Marsha V. Hammond, PhD