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Gov's Office, Health Department at odds over audit

The Governor's Office and the Arizona Department of Health Services were pitted against each other during a hearing on the fractured condition of the county's mental health care system.

The purpose of the May 18 hearing was to review the results of a recent court audit of Magellan Health Services, a private company that contracts with the state to provide mental health care to the residents of Maricopa County. Similar hearings have been held almost annually since a 1981 decision in Arnold v. Sarn guaranteed every citizen in Maricopa County the right to mental health care. 

Court Monitor Nancy Diggs conducted an audit in 2008 that found several deficiencies in the county's mental health system and called for comprehensive reform to address the shortcomings.

Earlier this month, the Governor's Office responded to the audit in a brief filed with the court, essentially agreeing that there is a crisis in the mental health care system. The governor also requested more time to address the problems.

A response filed by Health Department officials, though, denies any problem with the system and attacks the accuracy of the audit.

Maricopa County Superior Court Judge Karen O'Connor focused the hearing on the difference between the responses from the two named defendants and spoke only generally about the audit itself, said Chick Arnold, one of the named plaintiffs if the case and the lawyer for the court monitor.

"It seems clear to me that (O'Connor) wasn't pleased with the disparity in the two positions," Arnold said.

The state Health Department was unavailable for comment following the hearing.

The hearing was originally scheduled in February, but it was postponed to give the Gov. Jan Brewer more time to respond to the audit.

Diggs' audit, the first full-year review conducted since Magellan took over the contract from ValueOptions in 2007, was based on findings from 316 randomly selected consumers with a serious mental illness.

The audit revealed that Magellan had developed complete treatment plans – known as ISPs – for less than 20 percent of high-priority patients.

On top of that, only 62 percent of high-priority patients – those deemed most at-risk of hurting themselves or others – with completed treatment plans were allowed to participate in the formation of those plans, as required by Arnold v. Sarn. Under ValueOptions, by comparison, more than 79 percent of patients participated in the development of their treatment plans.

The audit also revealed that only 40 percent of high-priority patients had an adequate clinical team. The rest have received only partial treatment and are more likely to not receive any treatment at all. And clinical teams failed to meet with 36 percent of high-priority patients as frequently as the lawsuit requires.

Diggs concluded the audit with a call for "dramatic reforms and a complete overhaul" of the mental health care system.

The state Health Department filed a brief with the court, responding directly to Diggs' call for reform. The audit's results, according to the brief, are "not supported by the facts or evidence."

Health Department officials went on to state that an "objective look at the behavioral health system reveals that the system is improving and that progress has been made."

Dr. Richard Clarke, CEO of Magellan of Arizona, admitted certain areas of the system need repairing, but he said dramatic changes could threaten the progress Magellan is making.

"We are a system under transformation," Clarke said. "The system doesn't need to be overhauled. Instead, we need to keep pushing for deeper and broader positive outcomes."

In her brief, Brewer expressed concern that the system is facing challenges more than a decade after the initial filing of the case. The Governor's Office laid out loose plans for the creation of a task force and asked the judge for more time to organize a "collaborative process to improve the overall system in Maricopa County and statewide."

O'Connor criticized the Health Department for failing to recognize the failures of the system and refused to hear from the department's lawyers. On the other hand, Arnold said, the judge appeared supportive of the governor's approach to reforming the system and granted Brewer 60 days from the close of the legislative session to present a more detailed plan for implementing a task force.

Joe Kanefield, general counsel for Brewer, said the Governor's Office might not be able to submit a comprehensive plan to the judge within that deadline.    

"To commit to any timeline is unrealistic at this point," Kanefield said. "I don't know if there is anything that has occupied more of her time and attention, second to the budget, than review the behavioral health system. But the system is very complex and we can't expect any quick fixes."

Mental health care advocates said they are concerned that any task force created by the governor will not reach a conclusion in time to impact the re-bidding process that Magellan will undergo in June 2010. 

Arnold said he has been disappointed more than once over the years by the stall tactics used by the department and the Governor's Office. He's hoping Brewer will change all that.

"The governor is going to make the difference," he said. "She has unique experience in the process and understands the problem from the ground up. That is something we have not had in the past when dealing with the problems in the system."

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