Mental Anguish

Rescuing the mentally ill has brought millions to the Mental Health Corporation of Denver--as well as complaints of coercion, mismanagement and neglect.

"I still get mad when I think about it," says Harmer. "They were just ripping these people off."

Kay Robertson of Valdez tells of a visit last summer by an MHCD psychiatrist who met with five residents individually, for fifteen or twenty minutes each, and billed Medicare a total of $1,030--which works out to about $10 a minute. Other sources report an excursion to a Colorado Rockies game for which one case manager billed for every client present, whether the clients were assigned to him or not.

The recent state audit revealed other irregularities, including the case of the boarding-home client who'd apparently received only 25 minutes of case management over a three-month period. Still, Tom Barrett of Colorado Mental Health Services, the state agency overseeing the MHCD contract, says that the Medicaid billing is closely monitored by the state and that he's convinced the corporation is performing up to expectations.

"This is a very major program," Barrett notes. "There are some problems. But if you look at putting up $7 million a year in new services, plus reallocating millions more and having to do it very quickly, with lots of oversight and documentation--I think they've done a good job here."

McGuirk says the 25-minute case is "totally unacceptable" but that most of the deficiencies found in the audit had to do with a lack of proper documentation, not a lack of contact. MHCD recently turned to an outside transcription service to prepare its case notes, he explains, and that resulted in a backlog of notes not finding their way into the proper files. In order to beef up its client contact to meet the contract's requirements, MHCD is now stressing the amount of time a case manager spends with each Goebel client rather than the number of billable contacts.

"I never knew I was supposed to spend 9.7 hours a month with a client," says one case manager. "Now they have a memo out about it. Before, all they told me was to bring in $7,000 a month or so."

"We're reworking our whole set of expectations about client care," McGuirk vows. "We're moving aggressively to re-energize our whole delivery effort."

Part of that effort involves more frequent visits to the boarding homes. McGuirk says the case managers are supposed to be giving clients the opportunity to explore other living arrangements, not coercing them.

"Obviously, we don't want to take clients away against their will," he says. "But we do want them to have an understanding of the options that are out there--that life can be okay, even better, outside the board and care homes."

But some case managers paint a different picture of what's happening on the front lines, saying the push to move people out has caused them to question the therapeutic nature of their work. Steve Thomas says he had a schizophrenic client at the La Bonte Personal Care home who was easily upset by any prospect of change; the man broke down in tears during one visit to a smaller group home operated by MHCD.

"Forcing him out of La Bonte, it was like we were forcing him into the hospital," Thomas says. "It seemed like a strange thing to do, but they were telling us we had to have him out. I never understood that. These are still human beings. They're not numbers on a check."

The sign posted in Kay Robertson's cramped office reads: "If you are grouchy, irritable, or just plain mean, there will be a $10 charge for putting up with you."

The mock warning doesn't seem to deter any of the residents of the Valdez boarding home. They wander into the office all through the day with problems great and small, seeking advice, a compliment, a quick answer. Robertson handles them all with brisk matronly calm--and a hint of quiet exasperation, as if trapped in a play of uncertain origin, the scenes alternately heartbreaking and inadvertently comical.

While she shuffles through paperwork, a short, wizened codger tiptoes in and solemnly presents her with two stuffed animals--a white bunny and a pink elephant that look like they were obtained from a crane machine in an arcade. She thanks him and adds them to her growing collection. Ten minutes later he's back with a teddy bear. She thanks him again.

"Where are these coming from, dear?" she asks.
The old man grins mysteriously. "People give them to me," he says.
Another resident comes in fuming about a missing check. Robertson coaches him through a phone call to his case manager, and he ends up leaving a polite message. A heavyset young man sticks his head in the door and announces that he's going for a walk.

"No dumpsters, okay? I don't want you getting into any dumpsters," Robertson says.

The young man blinks hard. "Who's saying that?"
"I'm saying that. You're nice and clean, and I want you to stay that way."
"Go to the kitchen and ask them for a loaf of bread to feed the ducks."
"I'm not going that way," the man says.
"Which way are you going?"
He points away from Sloan's Lake, toward West Colfax. "Over there."
"You mean over by the pawnshop? Don't you try to charge anything."
"I'm just going to price things, that's all."

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