by Morgan True vtdigger.org Dan Quinn, the former CEO of Rutland Mental Health Services, was pressured to resign last week because of poor management. Sources say the state asked the board of the social service agency to take “bold action” and effectively asked that Quinn leave. His resignation comes on the heels of intensified state scrutiny. Officials cite a pattern of shortcomings in the care provided by the agency that contributed to a client’s overdose, a client being sexually exploited and several others being placed in neglectful or abusive situations, according to documents obtained by VTDigger. Poor management may have also contributed to one client’s untimely death.
Memos from the Agency of Human Services show officials are evaluating whether the agency should continue to receive state financial support.
In addition to Quinn, longtime CFO Tom Pour and Clinical Services VP David Long are expected to step down in the near future.
For the past six months, Rutland Mental Health Services has faced the possibility of losing its status as a designated agency, while it works with the state to improve practices and management.
Designated agencies are nonprofits that get exclusive state contracts to provide mental health, developmental disability and substance use services for a specified region. Eleven designated agencies in Vermont receive more than $300 million annually from the state.
Dan Quinn, former CEO of Rutland Mental Health Services. Courtesy photo
Ninety-nine percent of Rutland Mental Health’s funding comes from taxpayers, either through grants or Medicaid payments, according to a consultant report. In fiscal year 2013, the agency received $28.3 million from the state.
Stakeholder committees made up of clients, family and experts are appointed to review designated agency programs. The committees are expected to make a recommendation on Rutland Mental Health’s future at the end of the month.
The committees could recommend the revocation of the agency’s designated status or place it on a “provisional,” or essentially probationary, status as it works to improve its deficiencies.
The standing committee review is part of a redesignation process agencies must go through every four years. The state has final say on designation.
Hal Cohen, the secretary of the Agency of Human Services, wouldn’t rule out the possibility of Rutland Mental Health Services losing its status.
Such a move would be unprecedented. The state is loath to revoke a designation because of the potential fallout for the communities they serve. State officials were not aware of an agency losing designation since the program was started.
“(Revoking a designation) is in many ways very painful, in that there’s going to be a significant loss of services,” Cohen said. “Ideally, it’s better if we can work with an agency.”
Rutland Mental Health serves more than 3,000 people and has roughly 400 employees. It has been part of the community for decades, and there’s little doubt losing its designation would be a crisis for the region.
State investigations, usually triggered by complaints, can also lead to an agency being found out of compliance with its grant agreement. That happened to Rutland Mental Health last December, but temporary extensions have kept the money coming. The latest agreement ensures funding through the end of the month.
A pattern of mismanagement and neglect
Documents going back almost two years show a pattern of clients being neglected or placed in unsafe situations, and interviews reveal that Quinn did not communicate those problems to local lawmakers or the Rutland Mental Health board until state officials brought their concerns directly to the board.
Tom Depoy, a RMH board member, told VTDigger he felt pressure during the past six months from state officials to force Quinn out as CEO. Depoy, an alderman and former state representative, said officials never asked directly that Quinn be removed, but he was told numerous times the board needed to take “bold action” to shake up management.
“What it all boiled down to in the end is that the state was no longer willing to deal with Dan, but they never gave us a reason,” Depoy said.
Cohen denies that state officials pressured board members to oust Quinn (“that’s not our job,” he said), but he said he did have concerns about RMH management. Cohen did not offer specific examples of problems with management, except that Quinn was a voting member of the board until earlier this year.
Secretary of Human Services Hal Cohen on Thursday. Photo by Elizabeth Hewitt/VTDigger
After Cohen questioned the situation, which he called “unique” among nonprofits in the state, the board changed its bylaws in April to remove the CEO as a voting member, minutes from a meeting that month show.
Cohen said the management concerns should have been plain to the board through communication from the state and a staff survey.
A May employee survey showed the agency had a “retaliatory” work environment, Depoy said, and the impact of Quinn’s management on staff morale was clear to him.
“Dan’s management had a negative impact on people who worked under him, I don’t think there’s any doubt about that,” Depoy said.
Quinn, who resigned last week, could not be reached for comment despite multiple efforts to reach him.
Interim CEO Dick Courcelle would not agree to an interview, and provided the following statement in response to a VTDigger query: “The leadership of Rutland Mental Health Services is working aggressively to address all concerns raised by the Agency of Human Services over the past months while we continue to provide critical services to our clients.”
Courcelle would not permit anyone else from his organization to be interviewed.
An untimely death, abuse and neglect allegations
Last year a 13-year-old waited nearly six months to receive mental health services after being hospitalized for depression. She took her own life before she was able to get into treatment with RMH, although she had seen another therapist while waiting, records obtained by VTDigger show.
It’s unclear from the record if miscommunication between RMH and the teen’s mother contributed to the lack of treatment. State and RMH officials won’t comment on specific cases, making it difficult to clarify, but the teenager was an agency client at the time of her death.
In three instances in 2014 RMH placed clients in abusive or neglectful situations with contractors hired to provide residential services. Rutland Mental Health oversees care provided to clients through third parties.
In April that year a client, who was in the care of a contractor, tried to take their own life by consuming 88 benadryl. The client was taken to Central Vermont Medical Center and survived the ordeal. The state alleges in subsequent communication with the agency that “safe staffing protocols” were not followed.
In June 2014, a RMH client placed in a “nursing home” was sexually exploited by a worker there. The victim, a woman, told a state official she and the contractor had a flirtatious relationship that led to her performing oral sex on him, and that they had numerous sexual encounters in locations around the facility including the hallways.
The client reported feeling “guilty and dirty,” and after observing how he interacted with other vulnerable women, she wondered if he was taking advantage of them, too. She was reluctant to come forward because she feared retaliation, and he often spoke of having a gun in his truck.
Staff corroborated her report saying the man behaved inappropriately with female coworkers. He was “touchy feely” and made jokes about female client’s body parts, they said. The matter was referred to police.
In another situation in November 2014, a client reported being locked in a bedroom by a caregiver who was frequently intoxicated and verbally abusive. The case was referred to Adult Protective Services whose investigations are not public record.
The Department of Mental Health did not provide the report for an incident of “harm to others” during the same period.
In November 2013, officials with the Developmental Disability Services Division received a complaint that an RMH client was in an unsafe situation. By the time an investigation began “staff were unable to see the shared living home where the events were reported to have occurred.”
An examination of the client’s new living situation revealed caretakers were poorly trained, medication was being administered improperly and there was no written contract with the person coordinating support services. Problems were not being documented or reported to the state in the manner required by Rutland Mental Health’s grant agreement.
Close to 130 caregivers across the state have contracts with RMH to provide residential care for many of its clients, according to the nonprofit. State oversight of those contractors typically begins when something goes wrong, and the agency is required to notify the state.
Designated agencies that contract out work are liable for ensuring the services meet specifications in a grant agreement with the state. Communications reveal RMH sometimes poorly documented or downplayed incidents reported to the state.
Quinn’s relationship with the state and elected officials soured in recent years
In December of last year, the state’s frustrations with RMH boiled over.
Vermont Department of Health Commissioner Harry Chen testified last week before the Senate Committee on Economic Development. Photo by John Herrick/VTDigger
At that time Harry Chen, then interim Agency of Human Services secretary, and at least two department heads, paid management and board members a visit to express their dissatisfaction. Concerns raised at that meeting are reflected in a letter that also states the organization was [out of compliance with grant agreements].
Close to a dozen people interviewed for this story, both on and off the record, agreed that Quinn’s relationship with the state nosedived when Rutland Mental Health pulled away from efforts to open a methadone clinic in 2013.
Rutland Regional Medical Center eventually partnered with the state to open the clinic near the end of that year.
State Sen. Peg Flory, R-Rutland, said Quinn was “aloof” and communicated poorly with the county delegation. Flory said she never got an explanation for why RMH chose not to participate, except that there wasn’t going to be enough state money to make the clinic worthwhile.
Sen. Peg Flory, R-Rutland, at the Statehshouse in May. Photo by Elizabeth Hewitt/VTDigger
“We kept saying ‘Dan, if you had come to us we could have helped,’” Flory said. Quinn’s lack of communication around the methadone clinic and other projects was an ongoing concern during his time at RMH, she said.
Board members who agreed to be interviewed for this story said Quinn was concerned the state wouldn’t adequately fund the venture, and his organization would be left holding the bag. People close to that process, who asked not to be identified, described Quinn as incompetent and said the clinic was opened in spite of his erstwhile involvement.
Rep. Butch Shaw, R-Florence, said it he was disappointed when the agency “dropped the ball on the methadone clinic,” which he felt was a result of Quinn’s “lack of leadership.”
During the 2013 legislative session, Shaw and other Rutland County lawmakers went to bat for Quinn, helping him secure money for a four-bed residential facility. Sen. Kevin Mullin, R-Rutland, recalls administration officials insisting Quinn’s timeline for opening the facility was unrealistic and money for its construction could be approved the following year.
The administration was right. It was painful to see construction delays and watch as the project missed several opening dates, Shaw said. He can’t be sure what impact Quinn’s leadership had on RMH clients, but he was aware of concerns, Shaw added.
“You always hear rumors, and I did have contact from several of his employees complaining about his management,” Shaw said.
Sen. Kevin Mullin, R-Rutland. File photo by Anne Galloway/VTDigger
Mullin said several guidance counselors or school officials had raised concerns about the difficulty of getting troubled young people into treatment. He said he raised their concerns with Quinn several times. Quinn seemed responsive, but he also seemed “not be aware of what I was even talking about,” Mullin said.
The last time Quinn met with members of the Rutland delegation was March in Montpelier, Shaw said. Quinn said nothing about the state’s involvement with the nonprofit or problems with services, according to Shaw.
Depoy said Quinn never mentioned service quality issues to him either and he was “blindsided” when top state officials showed up in mid-December with their letter and a litany of concerns.
Depoy was one of two RMH board members who agreed to be interviewed (Board Chairman Chris Keyser was interviewed for a previous story, but did not respond to follow-up questions). VTDigger attempted to contact all current and one former board member who left last July. They either didn’t respond or declined interviews.
“In the interest of being transparent I think people out there need to know what’s going on,” Depoy said of his decision to be interviewed.
Quinn appears to have exerted a great deal of influence over his board members.
“I always had the feeling Dan had the full support of the board. Individual board members might occasionally shake their head, but I never heard much from any of them,” Shaw said.
Looking forward to a stronger agency
Depoy said turnover at RMH has been his greatest concern during his nine-year tenure on the board. It’s currently close to 25 percent annually, he said.
Board minutes state that turnover reached its highest level to that point in the organization’s history in the summer of 2013. RMH is not alone. Many designated agencies struggle to keep staff.
There are many factors driving high turnover at the designated agencies. The nonprofits serve very difficult populations, and bad things happen to clients even under the best circumstances, making the work stressful and often draining.
Their workers also make far less than counterparts working for the state, in the public school system or private practice. People working for the designated agencies typically make $15,000 less than a comparable state employee.
That’s partly because most designated agency service revenue comes through Medicaid, which reimburses roughly 60 percent of what delivering services costs, according to state health care regulators. Virtually all other designated agency funding comes through AHS grants paid by departments out of Medicaid global commitment money — a federal waiver program that allows flexibility in how the state-federal program spends.
Both the Medicaid rates for services and the grants made through global commitment are under increasing scrutiny from lawmakers writing tough budgets and within the Agency of Human Services, which is trying to better track the efficacy of its spending. AHS accounts for more than 40 percent of all state spending.
Despite those challenges, Depoy said he’s optimistic about the future at RMH. With new leadership and the state offering its help, he hopes the agency can improve.
“Staff confidence is up, they’re reinvigorated. It was time for a change and that change is happening. All we can do is hope for our clients that it’s a change for the better,” Depoy said.
Cohen is optimistic as well: “I’ve started to be encouraged by some of the steps the agency is taking,” he said, adding that “we’re in a process of moving toward change and improvement.”
TOP PHOTO: The offices of Rutland Mental Health Services. Photo by Morgan True/VTDigger