by Morgan True vtdigger.org Problems at Rutland Mental Health Services prompted a legislative hearing last week, which was a prelude to a review of all local designated agencies in the next legislative session. State officials placed Rutland Mental Health Services on probationary status this month. The nonprofit, which has an exclusive contract to provide social services in Rutland County, has seven months to create and implement plans to improve services that officials have described as subpar. Rutland Mental Health is one of 11 designated agencies in Vermont. The agencies receive state contracts to provide mental health, developmental disability and substance use services. The agencies receive more than $300 million from the state each year, and RMH receives more than $28 million annually.
Interim Rutland Mental Health CEO Dick Courcelle testifies before a House panel Friday, July 10, 2015, about service quality issues at his nonprofit. Photo by Morgan True/VTDigger
Problems at Rutland Mental Health Services prompted a legislative hearing last week, which was a prelude to a review of all local designated agencies in the next legislative session.
State officials placed Rutland Mental Health Services on probationary status this month. The nonprofit, which has an exclusive contract to provide social services in Rutland County, has seven months to create and implement plans to improve services that officials have described as subpar.
Rutland Mental Health is one of 11 designated agencies in Vermont. The agencies receive state contracts to provide mental health, developmental disability and substance use services. The agencies receive more than $300 million from the state each year, and RMH receives more than $28 million annually.
Management problems at Rutland Mental Health Services led to the forced resignation of the CEO, Dan Quinn, last month.
There were three major treatment incidents involving Rutland Mental Health in 2014: A patient overdosed on Benadryl, a 13-year-old girl committed suicide, and a client placed in a “nursing home” was sexually exploited by a worker there.
Members of the House Human Services committee at a hearing Friday struggled to understand why, after the state began working with the nonprofit more than 18 months ago, problems only started to be addressed in the past several months.
Rep. Ann Pugh, D-S. Burlington, chair of House Human Services, said the purpose of Friday’s meeting was to better understand what quality assurance measures are in place, and if they can be improved in the future to prevent services from deteriorating to the extent they did in Rutland.
Pugh said a review of designated agencies will be a priority for her committee when the Legislature reconvenes next January.
State officials provided a timeline of their involvement with the agency, which began November 2013 with an investigation into a RMH client’s unsafe living conditions. The Developmental Disability Services Division found caretakers were poorly trained, medication was being administered improperly and there was no written contract with the third-party coordinating support services. In April 2014 a client overdose triggered a similar investigation by the Department of Mental Health. That investigation found RMH wasn’t following “safe staffing protocols” at the time.
In mid-December 2014, officials representing all the departments in the Agency of Human Services that oversee client care provided by Rutland Mental Health collectively brought their concerns to the nonprofit’s top managers and board of directors.
Harry Chen, who at the time was the interim secretary of the Agency of Human Services, told lawmakers there are many dedicated, hardworking people at Rutland Mental Health and within state government who were trying to improve designated agency’s services. But ultimately the “severity and persistence” of problems led AHS to conclude “unified action” was necessary, Chen said. He has since returned to his role as Health Department commissioner.
Chen and other officials from both the state and Rutland Mental Health described the steps taken during the past year-and-a-half to make improvements. State quality assurance teams are working with the Rutland agency on specific service-related deficiencies.
Frank Reed, Department of Mental Health interim-commissioner, said staff cuts necessitated by tight budgets have reduced his quality oversight staff from four to two. Though other department experts are available to provide technical assistance to designated agencies needing to make improvements, the department’s ability to perform quality assurance reviews has been diminished, Reed said.
Officials from the Department of Aging and Independent Living, which oversees disability services, say they’ve “beefed up” their quality assurance team and have five staffers dedicated to quality oversight.
Rep. Topper McFaun, R-Barre, said looking at the timeline of events from November 2013, to the present “it’s all negative.” McFaun added that he was concerned there is still no accepted plan to correct problems that range from poor service delivery to inadequate monitoring and outcome reporting.
Rutland Mental Health and the state are working on a plan, according to Dick Courcelle, the nonprofit’s interim-CEO. Courcelle told lawmakers he couldn’t say why it took so long for the agency to begin addressing the problems in a systematic manner, because he only transitioned from an affiliated community programs division six weeks ago.
There was no discussion of what, if any, role former-CEO Dan Quinn played in frustrating efforts to make improvements. Quinn resigned under pressure last month, and many people involved said his poor leadership exacerbated the agencies’ problems.
Courcelle said lawmakers can be sure that things will be different going forward. His agency has a month to come up with a plan for improvement and six months to implement that plan.
“At the end of the six months I believe, representative, you will be satisfied with the response, but I understand those are words at this point in time,” Courcelle said.
He wants to get the agency back into regulatory compliance and ultimately provide exemplary services for clients, Courcelle said.
Allan Sullivan, AHS general counsel, said the regulatory oversight process is designed to bring designated agencies back into compliance rather than revoke their status — though that is an option.
No agency program has lost its designation in the 15 years the state has relied on the designated agency system, officials said.
Designated agencies have received exclusive state contracts for so long that in most cases other social service nonprofits couldn’t step in and fill the service void that would result if an agency lost its status.
Notably absent from Friday’s discussion was any mention of the waiting list at Rutland Mental Health for youth and family mental health services. A member of an internal RMH committee tasked with reviewing children’s services told VTDigger the waiting list can take months.
Last August, a 13-year-old girl committed suicide after waiting nearly six months to get into treatment with Rutland Mental Health. Officials refused at the time to answer any questions about the waiting list.
Pugh said lawmakers’ focus during Friday’s hearing was state oversight of designated agencies, but she acknowledged that deficiencies within specific programs at an agency are troubling and need to be addressed.