Change, Not Blame

As long as his risky investments were pouring millions into public coffers, Orange County Treasurer Robert L. Citron was a hero. But when his gamble on low interest rates suddenly turned sour in 1994 and tumbled his county government into the nation’s biggest municipal bankruptcy, everyone asked how such a thing could happen.

Similarly, the Ventura County bureaucrats who found ways to get Medicare and Medi-Cal reimbursements for mental health patients who hadn’t even seen a doctor were viewed as financial wizards as long as their scheme held up. But now that federal investigators have discovered illegal practices and demanded $15.3 million in reimbursement, everyone is looking for someone to blame.

Ventura County residents can be relieved that this sudden debt is unlikely to bankrupt the county, although it will make a lamentable dent in the county’s $25-million reserve fund. But it is time for some straight answers about what went wrong and how to fix it.

Above all, it is time to control the wildfire of politics that has made it so difficult for the county’s dedicated and hard-working mental health care providers to do their jobs for the past 18 months. While elected officials and their hired administrators bicker and backbite, the needs of the county’s mentally ill and their families continue unabated.

To the extent that power struggles and personality conflicts between former mental health director Randall Feltman and Health Care Agency Director Pierre Durand contributed to the problem, the buck clearly stops with the Board of Supervisors. The board has known about this feud for years and allowed it to fester. The board also has allowed the Systems of Care model to be steadily eroded and permitted millions of state dollars earmarked specifically for this program to be diverted to other uses--often uses that had little to do with the mentally ill.

Ironically, it was the board’s decision to merge the county’s mental health and social services agencies that drew federal attention to billing practices in the mental health department. The April 1998 vote of Supervisors Susan Lacey, Kathy Long and John Flynn--over the vigorous protests of Judy Mikels and Frank Schillo--cast the county into nine months of turmoil. In December, after it became clear that federal regulators believed the reorganization violated Medicare billing rules, the board rescinded the merger.

The U.S. attorney’s office launched an investigation after doctors complained their names and provider numbers were being used on Medicare claims for services actually provided by social workers, psychologists or nurses.

It was just one of several federal and state audits touched off by the failed merger. The U.S. attorney’s office took the lead on most of the federal inquires, including a separate one by the U.S. Health Care Financing Administration to determine whether the organization of the county’s mental health department complies with federal standards.

The $15.3-million Medicare reimbursement bill could be just the beginning; the county could be forced to repay millions more in state Medi-Cal reimbursements.

Amid the acrimony, suspicion and anger, the needs of Ventura County’s mentally ill and their families have taken a back seat to political infighting and empire-building. It’s significant that many advocates for the mentally ill welcomed the June appointment of Dr. David Gudeman--a Durand protegee--to head the Behavioral Health Department. Gudeman won their praise by proposing some of the same strategies that had been trimmed from the original Systems of Care program, specifically hiring a housing coordinator, adding more mental health nurses and expanding the crisis-intervention team.

The most productive course of action now would be to unravel how Ventura County’s Systems of Care model, a prototype copied up and down California and across the nation, got so far off track.

The supervisors must take the lead in closing the political and philosophical rift that has brought Ventura County to this expensive juncture. Innovation in providing needed services in the most efficient and cost-effective way should be encouraged, of course, but bending the law or using county authority to wage a personal vendetta cannot be tolerated.