Friday, April 30, 2010

Returning Vets: Loaded w/ Psychotropics & Committing Suicide at 18 / Day: Unheard of Rates Due to Reployment

What is the suicide rate of returning vets in Western NC, specifically, Haywood county?

Glenda Sawyer, a nice woman, last year gave out some brochures at a MAHEC training session(MAHEC is Asheville provider training created by associated medical school, meeting at Mission Hospital periodically). Ms. Sawyer indicated that Haywood Regional Medical Center was opening an arm of its mental health treatment program which would assist veterans and their families specifically.

Yet, I have yet to receive any referrals as associated w/ this center. Maybe they all get better w/ what there is but something tells me that if this is like NC Mental Health Reform, what we have is a break-down in communication between the referral site, as overseen by Ms. Sawyer, and the mental health providers.

This is what she says at the Haywood Regional Medical Center site associated w/ returning vets:

"....Glenda Sawyer, a behavioral health clinician with more than 30 years of experience counseling military personnel and their families, coordinates the center. Haywood County has more combat veterans than any other county in Western North Carolina, Sawyer said, and many of them are members of the National Guard. That is one reason the decision was made to open the center in Haywood County, she said........

The number one problem Sawyer said military men and women deal with is anxiety and sleep disturbance, which can compound over a period of time. Lack of sleep can lead to chronic irritability, heavier drinking and/or drug abuse, aggression, domestic violence, and depression, Sawyer said. Unaddressed problems tend to compound over a period of time, she said, so early intervention is important...."


Hidden toll of US wars: 18 veterans commit suicide daily
By Bill Van Auken 28 April 2010

The connection between the “surge” in military suicides and the ongoing wars in Iraq and Afghanistan is undeniable. The suicide rate within the military doubled between 2001 and 2006, even as it remained flat among the comparable (adjusted for age and gender) civilian population. And the numbers continue to rise steadily. In 2009, 160 active-duty military personnel killed themselves, compared to 140 in 2008 and 77 in 2003.

Many have blamed the increasing number of suicides on the repeated combat deployments to which members of the all-volunteer US military are subjected, with the so-called “war on terrorism” approaching its 10th year and nearly 200,000 US troops deployed in Afghanistan and Iraq.

.....According to a report in the Military Times last month, one in six members of the US military is using some form of psychotropic drug, while 15 percent of soldiers admitted to abusing prescription drugs over the previous month....."

Military Times link:

"....A key part of the new data shows the suicide rate is lower for veterans aged 18 to 29 who are using VA health care services than those who are not. That leads VA officials to believe that about 250 lives have been saved each year as a result of VA treatment.

VA’s suicide hotline has been receiving about 10,000 calls a month from current and former service members. The number is 1-800-273-8255. Service members and veterans should push 1 for veterans’ services....."

Monday, April 26, 2010

NC Medicaid : $500 MILLION 'unanticipated Medicaid growth' for 2010-11: We Don't Need No Stinkin' Public Option

Amazing figures in the just published NC Justice Center, BTC Reports, Volume 16 No1 April 2010. Naw: we don't need no Public Option when it comes to health insurance for $500,000,000 'unanticipated budget pressure' as associated with people going onto the Medicaid roster is surely no indication that people have health insurance that they can afford (or even obtain). page 7 :

Projected FY 2010-11 General Fund Budget Gap Anticipated Budget Pressures Unanticipated Medicaid growth $500,000,000 Unanticipated Community College Enrollment growth $85,000,000
Also, as associated w/ Community Suport Services (Mental Health: NC DHHS) in NC, they had this to say:

".....Cuts to programs that fall under the Health and Human Services (HHS) portion of the budget have also impacted individuals and communities. The deepest outright cuts to HHS programs were to community support services for people with mental illness and substance abuse issues and to personal care services that help individuals with medical conditions to remain in their homes and out of institutional settings. The mental health association of North Carolina estimates that 10,000 to 15,000 individuals currently need community support services but are unable to access them to due to funding constraints. ..." ________________________________________________________ The Treasure of the Sierra Madre (film) "....The bandits then reappear, pretending, very crudely, to be Federales, which leads to the now-iconic line about not needing to show any "stinking badges". After a gunfight, and the fourth American is killed, a real troop of Federales appear and drive the bandits away.,,,"

Friday, April 23, 2010

Fitzsimmons NC Policy: MH Services Re-funded by Perdue

Fitzsimmons: ".....The state does not have a spending problem. The budget debate has a right-wing rhetoric problem....."’s-mixed-bag-of-a-budget/

And then we have AP reporter, Gary Robertson, rah-rahing about how Perdue is going to 'stop that Medicaid abuse.' Pray tell what are you inferring is Medicaid abuse, Mr. Robertson?

But it plays well w/ the conservatives.....yeah, you stop taking my money and get those taxes lower.

Perdue has re-funded NC Mental Health Services but moved mental health services more towards a case-management format. Case management = papework. Paperwork does NOT = face to face contact w/ mental health providers. Why, then, do we need more paperwork? The paperwork needs to be DIMINISHED not undergirded further by creating case management formatting of mental health care associated w/ Medicaid.

Additionally, when was the last time you tried to eat anything without any teeth in your head?

Or how much money was spent on the person who could not go to the dentist and got a brain abcess via their sinuses due to the infection in their mouth?

The defunding of dentistry, as indicated by Fitzsimmons, is ludicrous. And I'm a psychologist, not a dentist.

I have clients who have to get a special form signed by a physician (ONLY) in order to get some dentures. And I have seen people die in ICU's from brain abcesses because they could not get a tooth pulled. What a stupid expenditure of money and sad loss of life.

Chris Fitzsimmons from NC Policy Watch:

".....The budget is a reflection of the perceived political climate in which elected officials seem scared to even discuss new revenues, even if it means cutting dental services and eye care for people on Medicaid or asking schools to find more cuts on top on last year's reductions that resulted in teacher layoffs and larger classes.......

Perdue also makes some important investments in repairing the gaping holes in safety net like restoring $40 million that was cut from mental health services in the final hours of last session's budget negotiations. That only gets the system back to less than zero, the underfunded state it was in before the cuts, but at least it's not going further backwards...."

Thursday, April 15, 2010

Mentally Ill Man Forcibly Transferred from his Family Care Home in Western NC to Another One (Where They Could Possibly Make Money Off His SSDI check)

Family Care Homes throughout NC are a place where many people, who would otherwise be homeless, live. For most of these residents, whom have been determined to be disabled---either physically or mentally or both-----their ability to stay there is associated with their Social Security Disability checks.

Specifically, except for $66/ month which they receive (and the homes take out the co-pays for medications from that $66), they surrender their disability checks. Most disabled people who receive Social Security Disability receive checks in the range of $600-850/ month, depending on how long they worked/ vested into the Social Security System. The difference is made up by funds funneled via the Departments of Social Services at each county.

It costs approximately $1250/ month/ person to live in such a place. What they receive for that is: meals; a room (commonly shared w/ another person); a person on the premises 24/7. This person administers their medications to them. They receive some transportation to medical facilities; they are 'supposed' to have organized social activities.

With the discontinuation of Community Support Services (CSS) as associated w/ NC Medicaid cuts, they are once again isolated and this is particularly so in western NC as many of the homes are placed outside of cities.

These people have certain rights which are outlined in the Family Care Homes law (see below). Posted in each of the houses is supposed to be a way to contact an ombudsman. However, many residents are very hesitant to file any complaints fearing reprisals from the management.

Additionally, this psychologist filed 5+ complaints early in 2009 to the Department of Health Service Regulation, which oversees NC Family Care Homes. For each county, there is a social worker in the Department of Social Services whose task is to oversee these issues which includes making surprise visits to family care homes.

As associated w/ those complaints, I received back discouraging notices that 'nothing was found to be amiss.' However, interestingly, Jeff Clifton, et al., who were managing WNC Homes in very very rural Leicester NC, and whom continue to manage Richmond Hills Homes, are no longer managing WNC Homes----the place about which I made so many complaints. But, just as they were pulling out of managing that family care home in Leicester, they jerked up one of my clients and moved them to their facility where (they figured) he would be happy to live.

Here is my letter to DSS Buncombe's Cheryl Simcox, the DSS social worker who oversees family care homes in Buncombe county as well as to Lou Morton, the Western NC representative for the state regulatory agency, the Department of Health Service Regulations.


Marsha V. Hammond, PhD Clinical / Health Psychology
Licensed Psychologist, NC
E mail:
Cell: 828 772 1127

April 15, 2010


Re: forced removal of family care home resident w/o his permission

Dear DSS Buncombe County & NC Division of Health Service Regulation (managing Family Care Homes in NC):

This is a continuation of my complaints leveled against the management of WNC Homes, specifically Jeff Clifton et al, whom, I understand manage Richmond Hills Family Care Homes.
No, I am not going to fill out any more forms as they appear to go nowhere but I am registering my concern about the welfare of my client as associated w/his forced removal from his domicile at the WNC Homes facility on Country Time Lane, Leicester, NC two weeks ago.

I understand that Jeff Clifton et al., are no longer managing this family care home, specifically WNC Homes, on Country Time Lane in Leicester, NC. However, the action was so egregious that I am registering my concern and would ask that you follow up on the matter. The client is afraid to speak out; he has a head injury and this caused him a great deal of confusion. I wonder how many other people have been drug out of their homes by managers who want to manage someone's Social Security Disability checks?

Approximately ten days ago, my client, ------------------ was taken, against his will, to Richmond Hills Family Care Homes which is managed by the same people as were managing WNC Homes, specifically, Jeff Clifton et al. The driver came into his room, told him to ‘get your shit together, we’re leaving’ upon which he was driven to Richmond Hills Family Care Home, where he did not want to be, and then, upon his dissatisfaction w/ this treatment, taken back to WNC Family Care Homes in Leicester, NC within a day or two.

Did not the ‘new management’ of the WNC Homes have anything to say about the treatment of their resident?

The Family Care Home Law, specifically, Subchapter 13G, Licensing of Family Care Homes, disallows such behavior by management.

I am looking forward to your response but frankly every time I have filed a complaint about the treatment of residents at WNC Homes, all I get back is that my complaint has been discovered to be ‘unfounded’ and I certainly am not going to any more meetings at DSS Buncombe County only to be verbally accosted by the likes of Mr. Clifton----with DSS Buncombe County personnel looking on.

Marsha V. Hammond, PhD

cc: Amanda Stone, DSS Buncombe; Cheryl Simcox, DSS Buncombe; Cathy Smith, Disability Rights NC; Mellonee Kennedy, Disability Rights NC; John Rittelmeyer, lead attny disability rights NC; Sarah Tarpey, DSS Buncombe caseworker;
Lou Morton, Western NC representative of the NC Division of Health Service Regulation; Barbara Ryan, chief investigator, DHSR; Brad Owen, Western Highlands Network LME;

LME's to Get Meaner / Leaner Under Proposed Cost Cutting NC State Legislative Proposal: IT'S ALL ABOUT CAPITATION and that=Accelerated Human Suffering

Years ago, when I had my son, I had Kaiser Permanente Insurance HMO, Health Maintenance Organization (read: capitated: see below). On the baby's due date, I was informed by the Primary Care Physician that I needed to go immediately to Northside Hospital, the baby factory in Atlanta (yes, I chose it because it was a baby factory) where I would be induced with pitocin as the amniotic fluid was too low and the fetus could roll over on his cord and die.

The medical staff induced me but they didn't give me an epidural to diminish the agonizing pain until they noticed that I was screaming so loud that I was disturbing the other women trying to deliver babies ("Could you be a little quieter?": I kid you not).

I got my epidural but not until it became so blatantly obvious that I had dropped into hell and they couldn't avoid spending the money to give me one. For Kaiser was a capitated plan.

I don't see much of a difference between that situation and the one that is being proposed by the NC State Legislature which is ALSO a capitated plan though associated w/ mental health services.

Here's the scoop on what has just been proposed by the NC State Legislature:

Item 41 Counties Pay Portion of LME

This reduction option proposes that counties pay a portion of the non-federal share

Systems Management Costin varying amounts depending upon the size of the LME. This reduction serves to(Effective Jan. 1 2011)incentivize counties and LMEs to achieve economies of scale and to become prepared to participate in 1915 Medicaid waivers. Counties for LMEs that do not meet the minimum size requirements per G. S. 122C-115 would pay the highest
percentage, sharing in the non-federal cost of LME Systems Management equally
with the state.

County participation would break down as follows:

Under minimum size per G. S. 122C-115 - 50%

Over minimum size, but LME Systems Management cost >$18 per capita - 40%

LME Systems Management cost between $14-$18 per capita - 30%

LME Systems Management cost < $14 per capita - 15% Participating in 1915 Waiver - N/A *****And so, you might ask, what is the 1915 Waiver?******************* see:

N.C. 1915 b/c WAIVER: WHAT IS IT?

Waiver - Request to CMS that provisions of the Social Security Act
(SSA) be “waived”

State wideness

Fee-for-Service payment requirements

“Any willing and qualified provider”

1915(b) waivers are commonly known as a “freedom of choice” or
managed care waiver

1915(c) waivers are Home and Community Based Services waivers
in lieu of institutional care, such as our CAP-MR/DD waivers

b/c Waiver combines services for all Medicaid funded MH/DD/SA
consumers into a single capitated funding model

Waiver Allows: The operations of a capitated manage care system
as vehicle for service provision to Medicaid recipients

.......Waiver eliminates “any willing and qualified
provider” provision - LME MUST ADDRESS
provider network
Improved Access to Services
Improved Quality of Care
Increased Cost Benefit
Predictable Medicaid Costs
Combine the management of
State/Medicaid Service Funds at the
Community Level

****And so, we've already had a pilot project as indicated in the presentation, specifically****:

......PBH or Piedmont Behavioral Health Pilot Project: Medicaid funded services for
MH/DD/SA on a capitated basis in the five county (Cabarrus, Davidson, Rowan,
Stanley & Union) area.

When would this waiver program be expanded?

......January, 2011: Planned Expansion Waiver Start-Up Date

********What's the basic problem w/ providing capitated health care services? *****

"Under the capitated system the doctors were paid a flat fee per plan member per month (known in HMO lingo as PMPM). Under this payment system doctors were paid a set fee (usually around seven dollars) each month whether or not the patient is a healthy one who rarely visits the doctor's office or a sick person who needs frequent medical care. The capitation system for a while seemed to keep everybody happy, except the patient. Well, almost. Insurance companies loved capitation BECAUSE IT MAKES HEALTHCARE COSTS MORE PREDICTABLE.

Employers welcomed the capitation idea because it gave them a less expensive medical plan for their employees.

Some doctors even initially welcomed it since it gave doctors who had difficulty building or maintaining a practice access to a huge volume of patients and a guaranteed monthly income.

In theory this new system of healthcare delivery might even allow previously uninsured families to finally be able to afford healthcare insurance. In practice the percentage of people without medical insurance is higher than it has ever been. The gatekeeper in the capitated system and insurance companies were making handsome profits. HMO executives got yearly injections of healthy bonuses and the bureaucrats raked in profits."

*****......And so, the question that is begging to be asked is this: IF the LME's, which are going to come online in terms of managing NC Medicaid more and more closely----- are more closely tethered to the counties----as is being proposed by the NC State Legislature Appropriations Committee----- will they simply function more efficiently and, as conjectured, also provide more seamless services?

For, after all, the LME's do not stand to benefit like the administrators of an HMO in terms of executives getting year end bonuses for such a swell job (read: they spent less money on the people who needed the medical care). But don't the LME's still stand to benefit by driving down the cost of mental health care in terms of the pressure that will come on them as per the county commissioners elected by the people------ vis a vis the penalty of the proposed 'cost per capita' which is being proposed by the NC State Legislature Appropriations Committee?

Very obviously the LME's will cut to the bone services whose efficiency is to be measured in the 'cost/ capita' of Medicaid mental health services. The counties that have the most diminished costs/ capita will require their citizens to pony up funds at a lesser rate. The pressure won't build immediately, but as the political cycles wax on, the 'no tax naysayers' will drive their points home as the county commissioners pick up heat as re: LME's that provide more services causing those counties to come forward and be punished for their 'lack of efficiency.'

Don't we basically have the same beast as Kaiser Permanente that standed to benefit when they allowed me to scream in pain for hours prior to an epidural as associated w/ the delivery of my son------since Kaiser would, after all, have to pay for that 'benefit' of the epidural?

I don't see any difference.

I can still see the face of the physician as she walked out of my hospital door, wagging her head, as associated w/ the blood in my urine due to the undue pressure of the pitocin which caused me to descend into hell-----and drop I did straight into a bottomless pit of suffering-----all because Kaiser Permanente had a capitated plan and waited to see if I REALLY needed an epidural.

Wednesday, April 14, 2010

NC DHHS Secretary Lanier Cansler Continues to Benefit from his Lobbying Company Which Seated Value Options Medicaid Contract

Cansler gets lobbying firm cash


The state secretary for Health and Human Services has continued to receive checks of about $3,000 a month from his former lobbying firm even as the firm helped land $30 million in no-bid contracts from the agency.

Lanier Cansler, a former Republican legislator from Asheville, says he stepped away from any role in awarding the contracts to avoid a conflict of interest. He said that before he returned to government service, he sold his stake in Cansler Fuquay Solutions, the lobbying firm he helped found in 2005. Cansler said the monthly checks are payments and interest for his share of the company, which he sold to his partner.Read


Here is my comment to that story:

mvh9355 wrote on April, 14 6:22 PM:

(1) Cansler earns a 300K salary

(2) when he was second in command at NC DHHS, in the early 2000's,he assisted Value Options, the company that authorizes NC Medicaid, in obtaining a contract to service Medicaid for NC DHHS

(3) some time around 2004/ 2005, he quit NC DHHS job & went into private business---you guessed it----lobbying for Value Options as per this Fuqua (sp?) Enterprises, his company; he was lobbying NC DHHS for his client Value Options

(4) when Perdue offered him NC DHHS Secretary job, using revolving door trick, he 'quit' lobbying job ('He only works for NC now', is the statement I recall from Perdue)to pick up helmsman job as Secretary of NC DHHS.

Mentally Ill Disabled Clients living in Section 8 Housing Can be Thrown Out using HUD Non-legal "Preponderance of Evidence" rule

Citizens assume that if a police-person knocks on your door----if you've got your wits about you----they must present a search warrant before you are required to allow them in your house. However, if you receive Section 8 Housing from HUD, if someone uses or sells drugs that is not prescribed to them or smokes marijuana, you can be immediately evicted from your home. If someone ACCUSES YOU of doing such you may be thrown out of your house.

LOTS of people with chronic mental health challenges live in Section 8 housing. In fact, I can't think of a single one of mine who does not get Section 8 housing assistance.

I have a client who is on probation for 5 years, w/ six months of that being 'intensive supervision' (read: the probation officer shows up at your door, demands to come in and inspect, and can speak to you pretty much anyway they like) for being in the company of a woman whom was his girlfriend; she sold someone two Vicodin pills in a setting which was not Section 8 housing; the Waynesville PD arrested him and threw him in jail for a couple of weeks while he waited for a court appointed attorney.

EVEN THOUGH all charges were dismissed save one, and he was given probation for that (and required to pay the court over $3000.00----he's got five years to do that, ya know), he has lost his Section 8 housing for three years. The difference for his household, which includes his elderly mother, is $200/ month loss. That's a 25% bite out of the money coming into the household. No, there is nowhere cheaper to live.

Another disabled client, living in Asheville, was demanded to 'turn over your pot' to the Asheville PD and he emptied his pockets on the spot of two joints. They marched into his apartment without needing to ask for or show anything.

According to HUD Section 8 housing paperwork given to me by Mountain Projects in Haywood county, Waynesville, NC, with the copyright 2002 by Nan McKay & Associates (why isn't this HUD paperwork if they are using this like a manual which prescribes what they can do to Section 8 housing recipients?), the 'Required Evidence' which is the term utilized to throw the person out of their Section 8 housing is this:

"Preponderance of evidence is defined as evidence which is of greater weight or more convincing than the evidence which is offered in opposition to it; that is, evidence which as a whole shows that the fact sought to be proved is more probable than not. The intent is not to prove criminal liability, but to establish that the act(s) occurred. Preponderance of evidence may not be determined by the number of witnesses,but by the greater weight of all evidence.

Credible evidence may be obtained from police and/ or court records. Testimony from neighbors, when combined with other factual evidence can be considered credible evidence. Other credible evidence includes documentation of drug raids or arrest warrants.

The PHA will terminate assistance for criminal activity by a household member, as described in this chapter, if the PHA determines, based on a preponderance of the evidence, that the household member has engaged in the activity, regardless of whether the household member has been arrested or convicted for such activity.

The PHA will pursue fact-finding efforets as needed to obtain credible evidence."

(Section 15-9 06/01/02 AdminPlan)

I have seldom read any 'legal-like' statement-----which has the power of throwing someone out of their house immediately-----that was more convoluted, conveying the least amount of information possible.

Lewis Carroll's Alice in Wonderland comes to mind:

"`.....Then you should say what you mean,' the March Hare went on.

`I do,' Alice hastily replied; `at least--at least I mean what I say--that's the same thing, you know.'

`Not the same thing a bit!' said the Hatter. `You might just as well say that "I see what I eat" is the same thing as "I eat what I see"!'

`You might just as well say,' added the March Hare, `that "I like what I get" is the same thing as "I get what I like"!'

`You might just as well say,' added the Dormouse, who seemed to be talking in his sleep, `that "I breathe when I sleep" is the same thing as "I sleep when I breathe"!'