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"We're really pushing the issue of getting people moved out of the boarding homes," says MHCD deputy director Frank McGuirk. "This gets to be an economic issue for the owners; they're able to draw a more significant amount of [government] dollars for clients with disabilities. I think they see this as a threat to their livelihood."
Such talk infuriates Kay Robertson, who worked at Highlands in its last months and now manages Valdez. She claims it's MHCD staffers who are trying to dictate where her residents will live, in defiance of the spirit of the Goebel plan, which states that MHCD services will be offered "on a voluntary basis and with due regard for the class member's dignity and personal autonomy."
"They're coming in here and intimidating the residents," Robertson says. "They're telling them they have to move, whether they want to or not."
Providing the services mandated by the Goebel plan has been a sizable undertaking for MHCD; the annual budget for the services amounts to more than $17 million in new and redirected funding, much of it coming from Medicaid coffers. Goebel clients--defined as anyone who has received treatment for chronic mental illness while living in central or northwest Denver at any time since 1981--now represent roughly half of MHCD's total customer base. But the program also has brought additional scrutiny of the mental-health giant, which has been plagued by staff turnover and management shakeups in recent years.
Two months ago Colorado Mental Health Services director Tom Barrett put MHCD on notice that it was in violation of its contract with the state, after a random audit of MHCD client treatment charts revealed that several clients had only minimal contact with their case managers. Although the accuracy of the records is also being questioned, they reflect that one client received only 25 minutes of "case management services" over a three-month period. The Goebel plan, Barrett notes, calls for each client to receive upwards of nine hours of such services a month. "In many instances, they were receiving less than half of that," he says.
Charges that clients aren't receiving the expected services are also being raised by some of MHCD's own employees. A dispute over billing practices and the amount of time case managers are supposed to spend with clients prompted several resignations last month on one of the high-intensity treatment teams, which target those who are considered most "at risk," including homeless and dual-diagnosis clients (people with substance-abuse problems as well as mental illness). Some former staffers complain that MHCD emphasizes producing hefty billings over serving the clients.
"It was all about money," says former case manager Steve Thomas, who quit after confronting superiors with his complaints about a colleague's conduct. "It wasn't about saving someone's life. MHCD's motto is 'dedicated to quality mental health care.' It isn't quality. It's quantity. It should be 'dedicated to billing Medicaid and Medicare until they're bankrupt.'"
MHCD's McGuirk characterizes the staff complaints as "minor, isolated items that have been blown out of proportion." At the same time, he ac-knowledges that the corporation is in the process of making some "administrative changes" to address the state's concerns and to work more smoothly with its boarding-home clients. None of which, he adds, should obscure the fact that the Goebel program has its share of success stories: "There are lots of clients who've seemed beyond hope, sort of lost in the system, who have achieved much, much more than anyone thought they would."
But there are also clients who have found the plan to be an experiment in misery, a persistent threat to their established routines and familiar surroundings. Recently Sam Haigler's sister and brother-in-law, his personal representatives, wrote a letter to a psychologist at Valdez expressing their "disapproval and disbelief" that MHCD was still urging Sam to move out despite the previous apartment disaster.
"To put Sam back in an unsupervised living environment would be unconscionable and irresponsible and would endanger Sam and others," they wrote. "Leave him in a setting where he is functioning, protected, and of no potential danger to anyone."
Haigler says his case manager hasn't mentioned moving in the past few weeks. "Maybe they're getting the message," he says.
Keith Roland sent an even stronger message to MHCD concerning his son Donald, a forty-year-old schizophrenic who wanders through the dimly lit halls of Valdez wearing Denver Broncos sunglasses that hide his wide, childlike blue eyes. His cigarettes and coffee are tightly rationed by staff--because, he explains, "I give too many things away and I could burn the place down."
When MHCD staffers talked to him about moving to a smaller group home, Donald became so upset that he went outside and began shouting at his father--who wasn't there to hear him. When Keith Roland found out about it, he fired off a letter to MHCD stating that the corporation's actions "border on harassment."
"The main thing I'm concerned about is that Donald is happy where he is," Roland says. Valdez may not be a palace, he adds, but it's clean, safe, and close enough for Keith, who lives in Westminster, to make regular visits. "It's like a five-star hotel compared to some of the places Mental Health put him in."