Thursday, July 31, 2008

Coward defends McDevitt's 5 yr contract as head of largest LME in NC,Smoky Mountain Center LME : YOU CAN KISS MH SERVICES IN WESTERN NC GOODBYE


If I lived in one of those old counties, and if I was a commissioner there, I'd be documenting all the denials of services with the expecation that NOTHING WILL CHANGE UNTIL 2013, when McDevitt's contract expires.



What's the problem w/ that?

*Meridian Behavioral Health Services which spun out of SMC LME and is headed up by former SMC retired employee, Joe Ferraro, is being awarded the lion's share of the MH work. Meridian is manned mostly by non-professionals who are paid $10/ hour in order to do what professionals formerly did.

*qualified professionals are required to undergo 20+ hours of non-paid, unnecessary training in order to offer therapy under CSS, something they were well trained to do in their doctoral programs

*Medicaid post payment reviews at the hands of SMC LME's Utilization Review Department manager, Charles Barry, is punitive and attempts to silence the complainers

*Steve Puckett, PhD, the clinical manager, disallows any therapy services for state funded clients by employing punitive, unnecessary overviewing of 20 page Person centered Plans that should be acceptable for the miserable nunmber of therapy hours allowed by SMC LME

*no one who knows what SMC LME has been up do wants ANYTHING to do w/ SMC LME.

*and CSS is being constantly defunded (another reduction 2 weeks ago to no more than 8 hours/ week, which includes case management)

Nice timing, Tom McDevitt (head of SMC LME for the past 8 years and continuing on, along w/ his daughter in medical records and his wife who manages the real estate: you waited until the northern counties, eager to curry favor and vote for you, came on board so they could out-vote the older counties WHO KNOW THE STORY OF HOW MH SERVICES ARE SUB-STANDARD UNDER SME LME.

week of 7.30.08

Divided board OKs mental health director’s contract
By Julia Merchant • Staff Writer

"...(SMC LME) board attorney Jay Coward said that wasn’t necessary. Any board decision to terminate McDevitt would be up for interpretation and would probably be contested in a court of law anyway, regardless of whether there was more clarification in the contract.

McDevitt took issue with the vagueness of the interpretation of what it meant to fail to act in the Smoky Center’s best interest.

“I think it’s so vague and ambiguous that anything I don’t do in the satisfaction of the board gives them reason to terminate my employment,” he said. He said an independent party, like a court of law, should be in charge of evaluating whether he acted in the best interest of the organization.

Ironically, McDevitt came under fire at the last board meeting for the same thing he was protesting. At that time, McDevitt attempted to amend the bylaws by including a phrase allowing for the termination of a board member at any time if they expressed negativity or criticism toward Smoky Mountain Center. The board protested and the phrase was removed.

During the meeting to approve the contract, board members raised questions about some of McDevitt’s practices. Smoky Mountain Center’s nepotism policy was a topic of concern. McDevitt’s daughter is employed by the organization, and some questioned whether she received special treatment.

McDevitt defended her employment, saying her position in medical record disposal was temporary and would be finished within eight weeks. He said the nepotism policy had become somewhat lax because of the difficulty of finding qualified employees, and that far from receiving special treatment, his daughter is the lowest paid employee in the agency.

The fact that the daughter’s position was temporary was news to Enloe.

“Never had it been mentioned to me before that it was a temporary job that would be ending,” she said.

Enloe asked about the involvement of McDevitt’s wife, who is a Realtor, in the sale of property owned by the Smoky Mountain Center.

“When Smoky sells or buys property, what real estate firm or agent handles that?” she asked.

McDevitt responded that the organization doesn’t own any property. Enloe then asked whether McDevitt’s wife was in any way involved in property transactions for the organization.

McDevitt said his wife is a Realtor with Main Street Realty, in Waynesville, though not a broker, and that “she’s been involved in assisting the foundation and purchasing properties.” The Evergreen Foundation is the private arm of the Smoky Mountain Center that owns the organization’s assets. McDevitt said that Enloe’s question was “answered in the affirmative at this point.”

Wednesday, July 23, 2008


My submission to Western NC Psychological Association, an admittedly good organization w/ well intentioned people who do not seem to have much of an idea of the limitations associated MH reform in western NC:

I might wonder what is the purpose of screening if there is no treatment? There apprently is no Counseling Center at AB Tech as per the statement below about the matter: "AB Tech will provide the referral list"

We already know that for Western Highlands Network LME that:

1. there are 8 max sessions of therapy/ year; more can be obtained if you have a personality disorder and you also obtain grp therapy utilizing DBT format (this is per the Utilization Review supervisor, Marsha Ring, WHN LME). Moreover, this is only obtained if the provider is willing to spend literally hours of time filling out the ever changing paperwork.

2. there are no psychiatric services to be had in western NC that I can turn up. The psychiatrists are all tied into organizations and/ or clients are referred to The Balsam Center which is Waynesville, NC. This is part of Smoky Mountain Center LME. Apparently there is such a shortage of psychiatrists and prescribing mental health people associated w/ WHN LME, that there is something of an agreement between the 2 LME's re: this matter. Good person to ask and an excellent friend of mental health providers, advocates, and clients is Doug Trantham, 828 586 5501, director of emergency services for SMC LME.

And if you still don't have enough information, might I suggest you survey the documentation of these problems per my NC mental health reform blogspot:

cc: Donald Reuss, Adult Provider relations, WHN LME


Hello WNCPA members,


Our first opportunity is scheduled for October 15th, 2008

The purpose of mental health screening days is to screen for anxiety and depression in college students and to offer referrals. Treatment is not provided.

AB Tech is in need of 11 psychologists from 9:30 a.m. to 1:30 p.m. on October 15th.


-Students arrive and fill out the screening tool (provided)

-After looking over the scored responses, the psychologist will invite the student into a

brief private discussion, offering a referral if need be

-AB Tech will provide the referral list

Tuesday, July 22, 2008

Community Support Services cut to less than 8 hrs/ week : Lawsuit waiting to happen: NO APPEAL IS POSSIBLE


The governor signed it and the state legislature created it.

The BIGGEST snafu re: all of this is that NC DHHS is attempting to block (no, scratch that), NC DHHS is blocking any appeals. Best I understand it, this is not legal.

There is a Charlotte NC attorney who has been working on this matter for a while now. His e mail: "Douglas Sea" . Law Practice: : Legal Service of Southern Piedmont.

Client help line: 704-376-1600

Outside Mecklenburg County: 800-438-1254
Spanish line: 800-247-1931
Administrative calls: 704-971-2622
Fax: 704-376-8627
Address: Legal Services of Southern Piedmont
1431 Elizabeth Ave
Charlotte NC 28204

Community Support Services have been cut again, now to less than 8 hrs/ week. The last major cut was in April, 2007 and at that time CSS was taken from an unlimited number to 12 hours/ week.

The tiered rate to be paid has not been posted by NC DHHS.

Then, over the ensuing year, a 'fade-in' of the requirements of the people who work directly with the Medicaid clients (forget the state funded clients CSS: they have had a whopping 4 hours/ week for some time now and remember that paperwork gets included in the 4 hours and so you see they get no CSS) of 25% of the time working with the clients needed to be done by a college graduates QP, and now 50%.

Now, there is no prior 'pre authorized' 4 hours for adults and 8 hours for children. "This means that the unmanaged 4 hours for adults and 8 hours
for children will no longer be allowed. Providers must request prior authorization before the delivery of any community
support services."

Remember: Medicaid is an 'entitlement' service and NC DHHS is putting a 'Benefit Limit' on CSS.

Basically, what is in place or about to go into place is the following:

* loss of many of the paraprofessional CSS workers' jobs as now 50% of the work must be provided by people w/ college degrees and 2 yrs of related experience (that is the basic requirement for a QP, Qualified Professional)

* there is little to nothing to be gained by the 'magic' of having a college gradute working w/ a client in terms of hands-on CSS. There are many very fine non-college graduates CSS workers.

Monday, July 21, 2008

Procedure to Obtain information about the functioning of your local LME Board

If you want to obtain the minutes as associated with the functioning, inclusive of funding, of your local LME, here are some useful guidelines passed to me by a helpful mental health advocate.

1. ask for the Board Packet, inclusive of minutes of the Board's meetings.

2. outline the beginning and end dates

3. when they try to bill you to death, cite the 'Public Records' matter below and cc either Mike Lancaster or Leza Wainwright, co-directors of MH DHHS NC:
"Mike Lancaster" ,"Leza Wainwright"

re: request for Board Packet records

July 21, 2008


Thank you for your reply (see below) as associated w/ my request for a 'Board Packet' beginning July 1, 2007 thru July 1, 2008 (you asked for the beginning and end dates). Such a packet would include the minutes of the ---- LME board meetings.

I can appreciate that ---- LME operates on a budget.

This being said, your cost seems excessive (see below). Calling around to copying services in the Asheville area, revealed: 10 cents/ copy

FedEx Authorized ShipCenter
Asheville Postage Express
22 New Leicester Hwy, Suite C
Asheville, NC 28806
(828) 255-9250

Additionally, state statutes indicate the following:

Chapter 132.
Public Records.
§ 132-1. "Public records" defined.
(a) "Public record" or "public records" shall mean all documents, papers, letters,
maps, books, photographs, films, sound recordings, magnetic or other tapes, electronic data-processing records, artifacts, or other documentary material, regardless of physical form or characteristics, made or received pursuant to law or ordinance in connection with the transaction of public business by any agency of North Carolina government or its subdivisions. Agency of North Carolina government or its subdivisions shall mean and include every public office, public officer or official (State or local, elected or appointed),institution, board, commission, bureau, council, department, authority or other unit of government of the State or of any county, unit, special district or other political subdivision of government.
(b) The public records and public information compiled by the agencies of North
Carolina government or its subdivisions are the property of the people. Therefore, it is the policy of this State that the people may obtain copies of their public records and public information

****free or at minimal cost*****

unless otherwise specifically provided by law. As used herein, "minimal cost" shall mean the actual cost of reproducing the public record or public information. (1935, c. 265, s. 1; 1975, c. 787, s. 1; 1995, c. 388, s. 1.)

NC DHHS continues to constantly change paperwork requirements which is CREATING A BARRIER TO MENTAL HEALTH SERVICES

Good News Everyone! (the last time I said this, on a mental health listserv, I was thrown off...seems they don't watch Futurama.)

When Professor Farnsworth says, "Good News Everhyone!", it means that basically very bad news is coming your way.

From Western Highlands Network LME (all the other LME's have to use the same paperwork):


Utilization Management News

We are asking Providers to implement the use of the new STR, and the new LME Consumer Admission and Discharge Form (LCAD). The Division introduced these in mid-June. The LCAD should be used whenever you admit or discharge consumers to begin or end an episode of care. Please use only these forms after 7/18/08. Please complete them in full, as much of the information is transmitted to the Client Data Warehouse (CDW) and will not be accepted when incomplete. After 7/18/08 we will no longer accept the PCP Admission Form.

Consumer Consent and Transfer Forms

Also note on the website that the WHN Consumer Consent and Transfer Form has been updated to the WHN Assignment of Case Responsibility/1st Responder Form. This form should be in exclusive use by July 30, 2008. After 7/31/08 we will no longer accept the WHN Consumer Consent and Transfer Form.

We will also be updating the Utilization Review Forms on the WHN website this week. Please transition your practice to the use of the new forms no later than August 15, 2008. After 8/15/08 we will no longer accept the old UR forms.

Saturday, July 12, 2008

"Insurance/ managed care plans can use utilization review to manage a mental health benefit" = WE'LL GIVE YOU THE SERVICES WE WANT TO GIVE YOU

A western NC mental health advocate has stated as re: just what can the LME's do with their money?:

"There is no entitlement to services by people who do not receive Medicaid, and then only a list of specific services (therapy is not one of them.) The $$ given to the LME can be use any way they want to use it, put in any kind of model or service delivery service and they and they alone decide who gets the service and who does not."

You would think that NCPA would have something to say about this, but narry a word.

I've posted this to Madame Defarge before, about a week or so ago.

There is, however, now an additional component now, namely Item 1, which indicates that indeed, 3rd party payers can manipulate, via Utilization Review, just as the LME's have 'managed' therapy for any diagnosis as associated with state funded clients (this is what they manage, the 'working poor', w/ no health insurance), such that therapy is basically not available. See Item 1, immediately below.

Pay heed to what is in Cameron's document and speculate on what is 'in between the lines'.....(she presented this to NC psychologists who are members of NCPA a month or more ago):

1. Cameron, Executive Director of the NC Psychological Association, which is supposed to represent NC psychologists, has been mostly mum about NC mental health reform. This is waht Cameron has stated re: NC mental health reform:

"Insurance/ managed care plans can use utilization review to manage a mental health benefit."

In western NC, Smoky Mountain Center (SMC) LME Utilization Management department indicates that NO therapy Basic Services are available to state funded clients.

Community Support Services (CSS) are utilized under SMC LME for therapy services for state funded clients.

My experience is that NO therapy services will be provided or very minimally (a handful, literally, of sessions) with the stipulation that clients be forwarded into Meridian Behavioral Services (headed by retired SMC employee, ,Joe Ferraro).

The fact is that Meridian's W.R.A.P. classes, associated with Meridian's contract w/ SMC LME, in Haywood county, have very minimal attendance now ( a year ago there were 20 plus clients; today there are 2 clients in WRAP classes).

Meridian's contract w/ SMC LME continues thru next July.

This means that state funded clients will continue to be funnelled into Meridian's non existent Recovery Education Center which is associated with WRAP classes and that no therapy services offered by professionals will be available to state funded clients, the 'working poor' without health insurance, until this contract is finished (at the very least).

Thus, Meridian is paid for non-services, as per their capitated contract (assumably) while willing providers cannot obtain authorization in order to be paid for services they are willing to offer.

I sent a Freedome of Information Act request for a SMC LME Board 'packet', which should include minutes of the Board meetings for the past 2 years (this is what I have asked for) as associated with the Winston Salem Journal's (online) coverage re: public record information, this past week. I have heard nothing. I presume my request has been forwarded to SMC LME attorney.

This is what I sent:

What I want to know is how much Meridian Behavioral Services is being paid for their (assumably) capitated contract in order to cover lives----which are not being covered-----while other providers drum their fingers on the table awaiting authorization to see clients.

July 9, 2008

Dear Mr. Tom McDevitt (, Director of SMC LME:

I am requesting a copy of the SMC LME board minutes for the past two years (June, 2006-June 2008). Specifically, I am requesting a copy under FOIA as well as per NC statute (see below) which allows me to receive such information.

Thank you. I will be glad to pay the usual copying costs or you may send those records via my private fax machine at my home: 828 253 2066.

Please send that bill to: 168 Virginia Avenue, Asheville, NC 28806.


Marsha V. Hammond, PhD

Published: July 6, 2008

"....Under current law, members of the public may request a public record without having to explain their reasons for wanting to see it. The law is based on the basic philosophy that a public record belongs to the public...."

Furthermore, in western NC, WHN LME's utilization department headed up by Marsha Ring has stated that no more than 8 therapy sessions are allowable for any state funded client, regardless of diagnosis.

Personality Disorder diagnoses can be offered more than 8 therapy sessions IF there is also group therapy offered to those clients which utilizes Dialectical Behavior Therapy (cognitive psychology).

This is the second item of interest as re: Cameron's post:

2. "The parity law does not cover the State Health Plan PPO plans (BCBSNC---this is my parentheses information; everyone avoids calling The State Plan as associated w/ BCBSNC) ----a strategic decision because the PPO plans have a broader benefit and includes parity for substance abuse."

Apparently, BCBSNC struck a deal w/ NC State Legislature---which supposedly overviews them----- which allowed them to opt out of mental health parity in exchange for they providing 60/40 payment (the usual poor payment for mental health services wherein professional providers are paid 60% of the allowed fee e.g., for 90806, 45 min of therapy, they are paid approx $55 or at least that is what this doctoral level psychologist is paid) for diagnoses associated with drug or alcohol abuse/ dependency.

We Spend More & We Get Less: National Public Radio comparison of costs of health care across US vs Europe & Japan

If NC Mental Health Reform is any indication of how $$$$$$$$$$$
are being wasted, in terms of heavy administrative costs (all those Endorsed Provider companies w/ all their overhead) and so much paperwork that providers cannot see their clients, then these stats also underline how STUPIDLY we manage our health care.

If we had universal coverage, we would not have all these problems w/ the LME's because THEY WOULD NOT EXIST IN THEIR CURRENT FORM which is to say that their existence is predicated on the fact that all they do is manage the UNINSURED or the state funded clients / working poor.

YIPEE! We're the weiners!

From NPR:

US: Health spending as part of GDP: 15.3% /// Coverage: 82% of people under 65; 100% of people 65 or over.

Japan: Health spending as part of GDP: 8% /// Coverage: 100 % -- all citizens and legal residents.

France: Health spending as part of GDP: 11.1% /// Coverage: 100%

Germany:Health spending as part of GDP: 10.7% /// Coverage: 99.8 % -- all citizens and legal residents

Great Britain: Health spending as part of GDP: 8.3% /// Coverage: Universal coverage. All citizens and legal residents.

Netherlands: Health spending as part of GDP: 9.2% /// Coverage: Universal coverage. 98.5% -- all citizens and legal residents.

Switzerland: Health spending as part of GDP: 11.6% /// Coverage: All citizens and legal residents.

Wednesday, July 09, 2008

Ignore the Professional Mental Health Providers, and They'll Go Away

There used to be a statement on the door of the Oral Surgeon at Grady Hospital in Atlanta : "Ignore your teeth, and they'll go away"

Ignore your professional mental health providers, and they'll go away.

Marsha V. Hammond, PhD Clinical Licensed Psychologist

affiliated (because I have to be as associated w/ NC Mental Health Reform) w/ Direct Care, LLC which is an Endorsed Provider under WHN LME.

July 9, 2008

Dear Bob Carey, Vice Chair of Western Highlands Network (WHN) LME CFAC:

You stated in an e mail that went out to several dozen people, the following:

"In my opinion they have at least one major flaw (re: The proposed rules for the Client Rights Oversight Committees were printed in the North Carolina Register on 7/01/08. Go to www.oah.state. register/)- it does not prohibit contract providers from being members of the LME committees. It would seem that contract providers would have an almost 100% potential conflict of interest position as they would be almost always dealing with clients rights protection compliance issues concerning themselves, their competitors, or their contracting agency (the LME).

Mr. Carey: I am an independent biller to Medicaid and Medicare & hopelessly unable/ unwilling to negotiate WHN LME's paperwork for my one state funded client who receives therapy.

That paperwork is of course mandated by NC DHHS. There are about 10 forms to fill out in order that a client begin to receive therapy. Did you know that?

If that was not bad enough, WHN LME changed one of its forms last fall; by the time the paperwork had moved from the receptionist at WHN LME network to the person to approve the services, the paperwork was no longer OK; it had to be revised.

Its simply not worth it.

Since the providers have no voice as re: this mental health reform in NC, something you seem to want to encourage, and since the provider's professional organizations like NC Psychological Association, look the other way, might I suggest that in order for you to salvage some of your professional providers, you know, the well trained doctoral ones, you might attend to their complaints.

I hope that my interfacing w/ you, a representative of the WHN LME CFAC is not going to be like my interfacing with the SMC LME CFAC.

For further information about the non-functioning across the state of the CFAC's please see my NC mental health reform blogspot, documenting problems in NC re: mental health reform since April, 2007:


Wednesday, July 02, 2008
What happened to the LME CFACS : the failed experiment that was written into law and ignored

I have had one state funded client under SMC LME also. (I am not interested in going beyond one; the purpose of one client is in order to test the waters and the waters are foul).

Today that client called me and told me that her drawing blood on herself had progressed back to the place where she was carving into her own flesh. There is no one to take care of her as associated with SMC LME pushing all of the state funded clients into Meridian Behavioral Health Service, run by retired SMC employee Joe Ferraro.

Meridian does not go out to her trailer; I do. Meridian does not take her calls late at night; I do. Meridian does not answer her e mails; I do.

I have sent her back to the ACTT team which referred her to me 2 + years ago. We were making good progress. I have walked her thru applying for medicaid; she is in appeal; that is very slow going.

If you want all of the well trained providers to move completely out of the state funded system and god help us if the LME's get ahold of Medicaid, then just keep it up, this talk about how the providers should have no input into NC mental health reform.

I understand your point about conflict of interest and it is a good point. However, if you do not listen to us in any manner, to my mind, it is the same as Tom McDevitt last week, as documented by Smoky Mountain News, telling the SMC LME board that he wanted to put into place a stipulation that the board members could not act in such a manner that would disallow the LME from moving forward.


See: Turmoil surfaces at Smoky Mountain Mental Health board meeting (week of 7.2.08)

"...It defined detrimental conduct as “the intentional misrepresentation of facts casting negative light on the board of LME, deliberate acts to undermine or impede the success of the LME board,” followed by several other sentences.

“It seems like it prohibits anybody from saying anything negative about the organization,” Cowan said. “I think that’s so subject to misinterpretation, like you couldn’t make a legitimate constructive criticism without being accused of trying to undermine the organization.”
This is what you suggested that smacked of that same attitude:

" It would seem that contract providers would have an almost 100% potential conflict of interest position as they would be almost always dealing with clients rights protection compliance issues concerning themselves, their competitors, or their contracting agency (the LME). "


Marsha V. Hammond, PhD: Licensed Psychologist: NC


pertinent information:

Consumer & Family Advisory Committee, Western Highlands Network... families in shaping the development and delivery of public mental health, developmental disabilities ... Vice-Chair: Bob Carey ... - 13k - Cached - Similar pages - Note this

Wednesday, July 02, 2008

What happened to the LME CFACS : the failed experiment that was written into law and ignored

Information, information everywhere and none of it being attended to re: the lack of functioning of the CFAC's as evidenced by the below information


If anyone has details about other CFAC problems, I would be glad to document this at Madame Defarge:
**What is a Consumer and Family Advisory Council or CFAC as per NC DHHS?
Each LME has a Consumer and Family Advisory Committee (CFAC). They are 'advisory' to the LME.

**Who appoints the members of a CFAC?
63% are appointed by the CFAC. One assumes then that 27% are appointed by the LME.

**Where is a good overview/ suggestions related to the functioning of CFAC's as per NC DHHS?

**What did the State CFAC, per NC DHHS, indicate were the problems re: mental health reform in 2007? (overwhelming number of problems):

**What did NC DHHS do when a member of the Centerpointe LME CFAC, as encouraged by Centerpointe LME, voted to disband the legally mandated CFAC?
".... Half of the CFAC members, with the assistance of Disability Rights N.C., sued the LME. They lost the suit.....the Consumer Empowerment Section of the DMH empowered the LME administration rather than the consumers in this argument."

**Is there any reason to expect something different from NC DHHS in terms of other CFACs and lack of support:

NO evidence is present per the NC DHHS website that indicates they would back the CFAC, as per their online guidelines, proposing assertiveness (but with a history of NC DHHS never having supported the functioning of a CFAC at:


Who is Laurie Coker? There is a page and a half on google about her very hard work as a mental health advocate in eastern NC.

participant in the following (as easily gleaned from google):

AND SUBSTANCE ABUSE SERVICES Advisory Committee Minutes Wednesday, April 12, 2006

**Chair of CenterPointe LME CFAC member

**Guest Speaker for CFAC meeting associated with Cabarrus, Davidson, Rowan, Stanly and Union Counties

The following statements are from Laurie Coker. This was shared with several dozen people who received e mails between myself and Laurie Coker in June, 2008.

As per google, and as per her own statements below, Laurie Coker was a member participating in CenterPointe LME's CFAC and ended her activity in 2005 along with some other members of the CFAC, with the apparent encouragement of the LME, voting to disband the CFAC.

AMAZING that they could get away with this. AMAZING. It speaks volumes to the lack of ability of consumers and advocates to provide input to NC mental health reform.

The below is her description of what took place.

It is posted here as a matter of documentation so that people can consult the information and realize they are not alone in their difficulties.

Moreover, it is posted on Defarge in order to alert people to what has already taken place so that they do not have to reinvent the wheel, which in this case, is completely broken e.g., the LME CFACS which were written into law by the NC State Legislature.

Laurie Coker, as per her below statements, stands behind the creation of NC-CANSO, seeing it as the best substitute for the broken CFAC system.

My opinion, as a provider, in a very different place than Coker, is that the LME's, though they do not yet have their fangs sunk into NC-CANSO at this time, may figure out just how to manipulate this new organization which is being, at this time, developed w/ support of the LME lobbying arm, NCCCP: North Carolina Council of Community Programs.Here is info on NCCCP:

Sorry: too much water over that bridge and too many wasted opportunities on the part of the LME's as they have ignored and profited even----at the cost of consumers/ advocates/ providers in NC.

I don't know the answer to this problem but I have a suggestion re: the defanging of the LME's. The LME's rule their areas like feudal lords.

Standardization of the Utilization Review across the LME's would be part of the answer in trimming their sails so that citizens can receive efficient mental health care.

I have asked for a meeting w/ Pat McCrory, the Republican gubernatorial candidate. I am a registered Democrat.

Would that I could see Bev Perdue attending to these matters but NC seems to be locked into death spiral as re: don't challenge the system in place which is run by the Dems.

The Joint Legislative Oversight Committee of the NC State Legislature, co-chaired by Verla Insko (D-Orange) and Martin Nesbitt (D-Buncombe) wrote the law. It has failed. What do they intend to do about it?

Laurie Coker's dismissal is in keeping with my inability to make any contact----at all----with the Smoky Mountain Center LME CFAC.

E mails/ telephone calls/ US Post letters all were for naught as associated with no mental health services for my state funded client. The Clinical Manager of SMC LME, Stephen Puckett, insisted she be funneled into Meridian Behavioral Health Services (run by retired SMC employee) Recovery Education Center (R.E.C.) which is manned by non professional, $10/ hour employees. SMC LME has a contract w/ Meridian as associated with they covering the mental health services of state funded clients (the only clients administered by any of the LME's in NC at this time) and it is extremely difficult if not impossible for other Endorsed Provider companies to provide services to state funded clients under SMC LME"s catchment area.

Here is Laurie Coker's statement about the failure of a CFAC. Some advocates may see this as a challenge to 'do better'; I think it is a grim assessment of how the CFACs have failed----and WILL fail----unless they are legislatively strengthened.

Laurie Coker:

"As far as I am concerned, CFACs have become, by and large, a failed experiment. But then again, so many of the products of reform have failed us in large part because we have little respect for the very policies we develop. One of our LOC co-chairs has said we have spent too much time on policy. But system thinkers from outside of our state say that it is our history of not implementing policy with due respect which has added to the mess we now have.

In deed, our statutes often translate to nothing. Our CFAC was "disbanded" when one of its own, without it having been even placed on the agenda, made a motion before the agenda for that meeting was even begun, that the CFAC be disbanded. Our LME director and board chair, who had begun to attend all the meetings, (arguably NOT in the name of forging a "constructive partnership"), sat by and, some feel, gloated. Those are harsh words, and sad to have to write.

Half of the CFAC did not wish to disband. There was no procedure in our by-laws to support disbanding, and the maintenance of an effective CFAC is actually one of the six primary duties assigned to an LME in Statute. Half of the CFAC members, with the assistance of Disability Rights N.C., sued the LME. They lost the suit, with the local judge stating that since the LME Board had by-laws that provided for its own disbanding, then the CFAC was protected to disband. So much for the independence and autonomy of a CFAC.

And sadly, the Consumer Empowerment Section of the DMH empowered the LME administration rather than the consumers in this argument. I will not go any further with details as it would simply impede the progress of the new organization, for the Division had not wished that House Bill 1888 would pass.

While I have not served on the CFAC since 2005, I have been as concerned as many other local citizens about the demise of our CFAC. I had already tried to encourage the Commission on MHDDSAS to consider writing rule which would help to strengthen the statute and perhaps develop an objective grievance process. But being one of a very few consumers serving on the Commission, the issue was easily dropped when Department (HHS) attorneys said we did not have rule-making authority in this matter. I disagree, considering the scope of the responsibilities the Commission is tasked with in Statute. But let's say I was weary of "speaking truth to power" without support and had begun feeling most conspicuous.

I think we (knowledgeable service users) have probably just been considered too cumbersome to include in processes at both state and local levels. I think it is the nature of bureaucracies to guard the status quo versus engaging new processes and people. For change is risky, and it is risk management that so many public agencies seem to keep at the fore, rather than solutions. CFACs are too much attached to the LMEs they are to advise. Yet ours has not been a service culture that is results-driven, so advisory input often feels divisive to people who were already comfortable with original results.

The NC Council is not so fixed in its own identity, from what I have observed through the past seven years. While it does have a lobbying role, it is not married to any particular service model, and in fact Council directors have been very frustrated that the Division has not properly implemented policies re: fiscal accountability, site visits, etc. For until we resolve to achieve a certain standard for/with our citizens, the status quo is less secure when some LMEs behave as they have."