Is there a plan post-Commonwealth Center? Of course there isn’t
January 7, 2009 by afp
Filed under *Blogs-Commentary
The state is closing the Commonwealth Center for Children and Adolescents as part of a strategy to shift mental-health care for children to the private sector and local community services boards.
OK.
Except that the closing is the result of the state budget shortfall.
Got it.
I think we have our real motivation right there.
“The proposals that are part of the governor’s budget have been put together thoughtfully over time, but clearly it’s been a response to the crisis of the current economic picture, which I know that everyone knows about, which the state has been struggling with in terms of the recession and the impact that it has had on state revenues and the around $3 billion shortfall that the governor and his staff have been struggling with,” said Jim Reinhard, the commissioner of the Department of Mental Health, Mental Retardation and Substance Abuse Services, at a meeting with CCCA staff and community and state mental-health advocates this morning in Staunton.
Reinhard and Secretary of Health and Human Resources Marilyn Tavenner led a discussion of the June 30 CCCA closing that has been proposed in Gov. Tim Kaine’s amended budget for 2009-2010. In the process, Reinhard and Tavenner made clear that budget considerations were at the heart of the decision to close the Commonwealth Center, a 40-bed facility that provides mental-health services to children and adolescents who by and large are not able to get those services from private-sector providers.
That dollars and not sense is the driver to the move was made plain when Reinhard made it known that the state is in the “beginning stages” of developing a plan for ensuring that the children and adolescents who currently can’t get services anywhere else will be able to access mental-health services after June 30. “There are lots of the parts of this plan that need to be developed. We will admit to that,” said Reinhard, a board-certified psychiatrist who has led the Department of Mental Health, Mental Retardation and Substance Abuse Services since 2002.
“We have already heard concerns from many, many people, gotten e-mails, gotten calls. We have heard from your legislators. We have heard from staff. We have heard from family members. As I had mentioned before, we know the need that’s out there. We recognize that family members have been desperate for the services that have been provided here,” Reinhard said.
“In an ideal world, we would have liked to have been planning for this specific budget-reduction proposal over a several-year period. That would have been the best scenario. We don’t have that. We have an economic crisis in our country and in Virginia, and the governor and the General Assembly will be facing that,” Reinhard said.
“We wish we had the luxury of planning in the way that you talked about. We don’t. Are the plans all in place? I would be foolish to stand up here and say that we have them all in place,” Reinhard said.
Well, thanks for clearing that up. Common sense would seem to dictate that if the closing was really about a long-term strategy to shift the service burden from the public sector to the private sector, then one could imagine that the state would have had a detailed plan long in place, given that we’re talking about a June 30 closing that is only six months away. I mean, you wouldn’t just set a closing date and then talk about setting up meetings with service providers and advocates and community service board representatives with the sword of Damocles hanging over the proceedings. Right? Tavenner conceded as much. “That is a period of time that is about six months from now. So obviously there is a lot of work that needs to be done in that six-month period,” said Tavenner, a former nurse who was appointed Secretary of Health and Human Resources by Gov. Kaine in 2006.
So why the dog-and-pony show about long-term trends in service delivery and demands that are not being met in parts of the Commonwealth and unsubstantiated claims that localities and regions that have not been utilizing the Commonwealth Center seem to have figured out how to manage without public-sector support when, as one advocate who spoke at this morning’s meeting pointed out, it could be just as likely that those localities and regions haven’t in fact figured anything out and are dealing with needs that are simply going unmet?
“Even though it may appear that we’re here representing lip service to the governor’s plan, I think it’s – I understand where you’re concerned about health crises, suicides, those kinds of things. This may be no consolation for something that is incredibly important to this group, very emotional for staff and families. I understand that,” Reinhard said.
Ah, yes, emotions are clouding the issue. Maybe that’s true for staff and family and advocates, but I’m none of the above. What I see is a solution being matched up to the wrong problem. The state is experiencing a budget shortfall, no getting around that. Cutting off our nose to spite our face is no way to work through that. And in the context of all the talk about increasing our commitment to mental-health system reforms in the wake of the 2007 shootings at Virginia Tech, that’s what it seems to me we’re doing here.
Allen on Wed, 7th Jan 2009 3:46 pm
Good post Chris. Thanks for covering this tragic subject.
Patrick on Sun, 11th Jan 2009 1:43 am
Here’s the another interesting note, our Virginia Secretary of Health and Human Services, Marilyn Tavenner, worked at HCA in Tenn. for years, just like Joey Jacobs, President and CEO of Psychiatric Solutions Inc., the nation’s and Virginia’s largest provider of psychiatric residential treatment center beds for children. Nobody seems to be looking at the connection between these two former HCA . (Not to mention Joey Jacobs and PSI’s huge political donations – $25,000 to Governor Kaine’s PAC and quite a bit to Eric Cantor in Henrico.) I wonder if their connection has anything to do with why PSI – Whisper Ridge in Charlottesville, VA only received a $30,000. fine from Virginia after the staff was sexually abusing the children in their care. I was at the hearing last week listening to Secretary Tavenner try to explain and justify this unplanned rush to turn the care of all Virginia’s mentally ill children over to private facilities, which will mostly be PSI facilities. Maybe Joey Jacobs and PSI (PSY on NASDAQ) are ponying up some money to help balance Virgnia’s budget?
Here is an interactive map of PSI’s ongoing legal struggles with providing quality care to their patients. Why does Virginia think this will improve with a monopoly?
http://www.propublica.org/special/map-problems-at-psi-facilities
http://www.hhr.virginia.gov/OfficeInfo/TavennerBio.cfm
http://phx.corporate-ir.net/phoenix.zhtml?c=135294&p=irol-govBio&ID=83018
David on Fri, 16th Jan 2009 5:49 pm
You are very clever and witty Patrick, and as much a I respect your opinion; I can’t relate even begin to think you are comparing Secretary Tavenner and Mr. Jacobs at all. Let’s try to pick out many of your misconstrued remarks; yes PSI has some cleaning up to do, but linking that to Secretary Tavenner? Tell me where in Secretary Tavenner’s bio has any controversy…..well?….she is the poster child of the American dream. Working her way up on her own, to where she’s stand now. I agree that the Commonwealth Center shouldn’t be closed. But since we live in a greedy economy and now it back fired on us Americans; people are going to lose their jobs. Prime example that Circuit City’’s logic to make money short term and not long term, has now cost about 35,000 people out of work.
Gov. Kaine’s proposals are a sensible approach. But the state operates over a dozen other psychiatric facilities, so there’s an opportunity to go much further in transforming the way the state delivers services to psychiatric patients. As one innovative project in Williamsburg—plus others in Florida, Georgia, and elsewhere—demonstrate, innovative policymakers around the country are increasingly turning to privatization to dramatically improve the quality of mental health services while holding down costs.
The Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services currently operates sixteen mental health and other residential treatment facilities, including Williamsburg’s Eastern State Hospital (ESH)-the nation’s first public psychiatric hospital dating back to 1773. By the late 1990s, conditions at ESH had deteriorated to the point that it became the subject of a U.S. Justice Department lawsuit to rectify substandard care and living conditions. In addition, the combined challenges of a decreasing patient population, obsolete facilities on a sprawling 500-acre campus, noncompliance with industry accreditation standards, and the potential loss of Medicare/Medicaid reimbursement dollars prompted policymakers to look to private sector solutions. To turn things around, the Department embarked on a large-scale ESH modernization project facilitated by an innovative public-private partnership. This multi-phase project involves partnering with a private contractor to consolidate 26 buildings into six; deliver new, state-of-the-art geriatric and adult mental health facilities; and develop a strategic plan for the 400 surplus acres generated as a result of the initiative. The first phase of the project—the new Hancock Geriatric Treatment Center—opened in April 2008 and recently won an innovation award from the National Council of Public-Private Partnerships. The next phase of the ESH modernization—a new adult mental health treatment center—is set to open in 2010. Do I need to compare the amount of jobs ESH created?
One of the more notable aspects of the ESH modernization is that the initiative did not come from within, but was received as an unsolicited, private sector proposal for turnkey development submitted under the state’s Public-Private Education Facilities and Infrastructure Act (PPEA). The contractor is not only delivering the new facilities on an accelerated schedule, but the efficiencies incorporated into the design will deliver tremendous future cost savings through dramatically reduced life-cycle maintenance costs. And because of the more efficient use of space on the campus and the patient-centric design of the new facilities, the partnership will deliver where it really counts—improving patient care, outcomes, and safety. Wow maybe Secretary Tavenner did her homework like she always done!
Just look at Florida, which has been the state leader in mental health services privatization. Since the mid-1990’s, the state has contracted with the private sector to operate several of its psychiatric facilities-ranging from large state hospitals to forensic psychiatric treatment centers to its civil commitment center for sexually violent predators. Florida’s efforts began in November 1998 when it contracted with a private company to operate South Florida State Hospital, an aging facility which had never been accredited in its history and which was facing a major class action lawsuit concerning patient abuse and poor conditions. Within two years, the private operator was able to achieve accreditation for the existing facility (removing the lawsuit), while at the same time financing and building a new, modern facility to replace it. No capital dollars were involved and the state will own the new facility when the debt is retired. The results speak for themselves-after privatization, the hospital reached some significant operational milestones, such as eliminated waiting lists for patient admissions, reducing the average patient stay from eight years to less than one year, and nearly eliminating the use of seclusion and restraints to manage patient behavior. Noting these improvements, the Florida Statewide Advocacy Council—a state watchdog group—unanimously passed a resolution in 2003 supporting further privatization of Florida’s psychiatric facilities.
And hey so you want it more supervised so we don’t have to hear another lame Joey Jacobs crack out of you; Virginia should do this, in this sort of arrangement, the state would negotiate a performance-based contract that would establish care standards and performance mandates (with appropriate financial penalties for non-compliance) to ensure a higher level of service than achieved under state operation. The state’s role then shifts to contract monitoring and holding the operator accountable for results. In Florida’s contracts, the state retains the ability to terminate the contract without cause with a mere 30 days notice, a provision clearly aimed at ensuring contractor accountability. Further, Florida has also negotiated fixed-cost contracts that effectively hold facility budgets flat over multiple budget cycles, a far cry from the budget variability typically seen under state operation. At a time when it’s more critical than ever to do more with less, Virginia policymakers need to ask a critical question: does the obligation to deliver high-quality psychiatric services necessarily require the Commonwealth to be in the business of running hospitals, or could it achieve better outcomes at a lower cost through contracting for performance with experienced private sector operators? The experience in Florida and elsewhere strongly suggests the latter approach may be the best answer in Virginia.
Secretary Tavenner inherited oversight of several of the state’s largest and most challenging agencies, including yes those dealing with mental health and retardation, substance abuse, the disabled, the aging and the ill. Health care is so complex and expensive, I’m not a Kaine fan by no means but he struck golde in this secretariat who are change-makers and can adapt to difficult realities.
So before you want to start pointing fingers and “name calling”, why don’t give up with the scandal bull crap, and just know the budget cuts weren’t maliciously directed on Staunton nor the Commonwealth Center. And if you want my research I’m more than willing to prove my points are correct .