Audit calls county's mental care worse
Monitor faults new contractor
by Casey Newton - Jan. 14, 2009 12:00 AM
The Arizona Republic
Maricopa County's mental-health system has worsened under its latest service provider and needs a complete overhaul, according to an audit released Tuesday by a court-appointed monitor.
Magellan Health Services won a three-year, $1.5 billion contract in 2007 on the promise that it would improve significantly over its predecessor, ValueOptions. But an annual audit shows the Connecticut-based company has fallen behind its predecessor in serving the county's 19,000 patients who have serious mental illnesses.
"The audit shows a pattern of regression and significant declines in a number of areas," wrote the monitor, Nancy Diggs. "Looking ahead, there is no reason to believe that other already initiated reforms will fare any better."
The system needs dramatic reforms, Diggs said.
The audit found that among patients with the most serious psychotic and mood disorders:
• 83 percent of clients are not having their behavioral-health needs met according to their treatment plans.
• Three in five patients do not have an adequate clinical team.
• Four in five patients do not have a complete assessment of their mental-health needs.
The audit further found that less than half of patients with serious mental illnesses are treated with dignity and respect, as measured by how quickly their phone calls were returned, whether their right to treatment was protected and whether patients were allowed input into their treatment plans.
"They've really gone to hell in a handbasket," Diggs said.
A Magellan spokesman said executives were reviewing the audit Tuesday and were not prepared to comment on specific findings.
Arizona is required by law to provide services for the seriously mentally ill but has a history of inadequate care that stretches back several decades. In 1981, advocates for the mentally ill successfully sued the state in Arnold vs. Sarn, which resulted in the creation of a court monitor to regularly audit the county health-care system.
Lawyers and representatives from the plaintiffs, Magellan and the state expect to have a hearing in Maricopa County Superior Court within the next few weeks to discuss their next steps.
A promise of change
When Magellan took over for ValueOptions in 2007, executives said that patients would have a wider choice of providers and that a governing board made up of patients, families and advocates would help ensure a higher standard of care. But, to date, few gains have materialized.
"We continue to be very disappointed in the results," said Dr. Laura Nelson, acting deputy director for the state's Division of Behavioral Health Services.
Nelson cautioned that Magellan is less than halfway through its contract and is still establishing a framework for mental-health care in the county.
"This audit is really only one picture of how the system is functioning," she said. "There are many other monitoring activities that go on here at the division to look at the quality of the services that are being provided. And there are conflicting findings at times. We're trying to better understand why that is."
The assessment took place in October, when 42 auditors reviewed the case histories of 316 randomly selected patients, conducted interviews and examined treatment plans and other documents. Patients came from each of 15 clinics Magellan operates in Maricopa County, and 15 of Magellan's own staff members were among the auditors.
Magellan responds
The state agency was not prepared to discuss whether it might seek to end its contract with Magellan early, Nelson said.
But the Arizona Department of Health Services has the ability to fine Magellan and has done so several times since the provider took over the contract.
In September, the agency fined Magellan $62,250 for failing to coordinate care with patients' primary-care physicians.
Four days later, Magellan named a new chief executive, Richard Clarke, to oversee the contract with Maricopa County.
More recently, the DHS released documents showing that staff at a Glendale mental-health clinic operated by Magellan failed to properly document consent for medication, update patient assessments and develop treatment plans.
The inquiry into the clinic came days after the Dec. 23 murder of two young boys in a southwest Phoenix park. Joe Gallegos, who has been indicted in the slayings, was a Magellan client who was supposed to receive court-ordered treatment.
Magellan spokesman Greg Taylor said the company strives to provide quality care.
"We care profoundly about the people we serve in this program, and we're committed to continuing to demonstrate that (the DHS) made the right decision to transition this program to Magellan," Taylor said. "This will be the first step toward transforming the mental-health system in Maricopa County."
The hearing that will take place in coming weeks will allow representatives from all sides to suggest ways the standard of health care can be improved.
"We need to advise (the DHS) of what we think needs to happen, sit down and see if we can come to some sort of agreement that would alter this current picture," said Anne Ronan, lawyer for the Arnold plaintiffs.
Meanwhile, Diggs said, thousands of patients are not getting adequate care.
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