Dr. Jennifer Wilson sent another letter to the Humboldt Board of Supervisors et al today. I printed her first letter. I also printed what NAMI Humboldt sent their members. Text of her letter (in italics)
Dr. Wilson does evaluations for court defendants. I have covered many court cases and mental health diversion hearings. The facts, the numbers, the salaries Dr. Wilson brings up is what the rest of the local media won't report. This is something national media should cover and this is something happening all over the country.
A lot of people make money off people with mental illness. Dr. Not mentioned in Dr. Wilson's letters are the property owners, landlords, property management who house individuals with mental illness. They are fine building their personal wealth on taxpayer funds but they could care less the conditions these residents live in. I can tell you from personal experience, supervision by DHHS is lacking. DHHS needs to check on these residents more often.
People refuse to take meds, neighbors and the community suffer. Like many other issues the Supervisors ignore what is happening. EPD ends up being called. They end up taking people to Sempervirens.
April 5, 2021
To: Humboldt County Board of Supervisors: Supervisors Bohn, Bushnell, Bass, Wilson and Madrone
CC: Karen Paz-Dominguez, Auditor Controller, Humboldt County
Connie Beck, Director, DHHS, Humboldt County
Emi Botzler-Rogers, Director, DHHS-MHB, Humboldt County
Paul Bugnacki, Assistant Director, DHHS-MHB, Humboldt County
Heather Cooper, County Counsel, Humboldt County
Lea Nagy, President, NAMI Humboldt
Robert Soper MD, Psychiatrist and Chair of BH Committee, Medical Society
Penny Figas, Humboldt-Del Norte Medical Society
Ruby Bayan MD, Psychiatrist and Medical Director of Waterfront Recovery Services
Marek Reavis, Public Defender, Humboldt County
Meagan O'Connell, Supervising Attorney, Conflict Counsel Office Humboldt County
Maggie Fleming, District Attorney, Humboldt County
Kim Bartleson, CEO of Humboldt County Superior Court
RE: The Board of Supervisor Resolution to Opt Out of Laura's Law- AOT (Assisted Outpatient Treatment) and by doing so Continue to Neglect to Provide Adequate Treatment to Patients With Anosognosia; Call for AUDIT of DHHS to determine where treatment funds are actually being spent
Dear Supervisors,
I am writing to comment on your plan to follow the DHHS recommendation of opting out of Laura's Law-AOT. I have carefully read the DHHS position paper rationalizing their desire to OPT OUT of offering AOT and I disagree with all four of their justifications which I will describe below.
It is my opinion that by neglecting to adequately treat our most ill patients in our county DHHS and the BOS are mismanaging public funds while getting paid full time salaries and benefits and that you are not upholding your legal responsibility to treat these patients. It is my opinion that DHHS should be audited to determine how they are using (and not using) public funds that the BOS is supposed to be overseeing.
The Humboldt County BOS and DHHS are legally responsible for the psychiatric treatment of ALL patients in Humboldt county that meet eligibility requirements for medical necessity for specialty mental health care, INCLUDING PATIENTS WHO ARE INVOLVED IN THE CRIMINAL JUSTICE SYSTEM. The BOS and DHHS do not get to decide which patients are eligible for treatment through DHHS. The state of California sets the requirements for medical necessity (not the BOS or DHHS). The BOS and DHHS are currently neglecting a large number of patients with anosognosia and justifying it by saying that funding isn't available. A quick look at the public record of total pay and benefits of Humboldt county DHHS administers, BOS, and county counsel staff in 2019 indicates the following: the total pay and benefits for Connie Beck, Emi Botzler-Rogers, Paul Bugnacki and Mark Lamers was over $700,000. The total pay and benefits for eight senior program managers at DHHS-MHB was over $1,750,000. The total pay and benefits for the BOS was over $600,000. The total pay and benefits to the attorneys at the County Counsel office was over $1,250,000. That means that Humboldt county paid out over $4,300,000.00 in one year (2019) to DHHS-MHB administrators, the BOS and the county counsel attorneys, none of whom provide actual patient care.
This does not include salaries of the direct treatment providers such as nurses, clinicians and case managers. This does not include the cost of the contract with Traditions (a private company) who has provided the psychiatrists at a cost of multi-millions of dollars every year since the BOS and DHHS failed to respond to the concerns the psychiatrists about inadequate treatment who then all resigned in 2015. Meanwhile the county receives public funds from MHSA, the DSH and the State of California every year which are the funds that most counties in CA are using on patients with anosognosia. (See my letter to the BOS dated 3/31/21 for more information on MHSA funds).
Where is all that money going? We know it isn't going to the treatment and staffed supportive housing of the most severely ill patients in our county. Everyone in our community can see the patients who aren't receiving proper treatment. Preventable local tragedies happen every year in Humboldt county due to inadqeuate treatment. In my current role conducting Court ordered MH evaluations at HCCF, I am familiar with the level of treatment being offered (and not being offered) to the most severely ill patients in our county (those involved in the criminal justice system). As part of my evaluations I review the jail medical and psychiatric records. I have conducted over three hundred fifty evaluations in the past three years. I disagree with DHHS's representations of what services are actually being provided and their assessment that only 4 patients in Humboldt county would be eligible for Laura's Law. Perhaps they are not familiar with the eligibility requirements? I personally have evaluated AT LEAST seventy five patients at HCCF who would qualify and benefit from AOT.
During my evaluations I review the past history preceding the incarceration. One of the common threads amongst nearly all of the patients I evaluate is ANOSOGNOSIA and resultant treatment nonadherence and homelessness. Most of the patients have had recent psychiatric hospitalizations on SV and incarcerations at HCCF and did not receive sufficient case management and staffed supportive housing from DHHS to remain treatment adherent after release. Patients inform me that upon discharge from SV and release from HCCF they are not given medications or given a ride to the pharmacy to pick up their medications or receive assistance getting to their psychiatric appointments.
Many patients inform me that they never obtained their medications and that they quickly relapse on substances and their psychiatric symptoms worsen until they have a psychiatric crisis severe enough that they are then either hospitalized or incarcerated again. Most of the patients inform me that the only housing options offered to them by DHHS are: local shelters, non-staffed Clean and Sober houses and inexpensive hotel rooms surrounded by other people who are also struggling with untreated psychiatric illness and substance use. When I was the jail psychiatrist for 8 years I had many patients there who never saw psychiatrists in the community because they were too ill to access treatment on their own. Many of these patients need Board and Care level of housing (staffed supportive housing) but in Humboldt County DHHS chooses to only offer that to patients on LPS Conservatorship.
I read carefully the DHHS:BH report to the BOS File #21-375 for the BOS meeting of: 4/6/21. I noticed that four main factors were used to rationalize NOT offering Laura's Law level of services:
redundancy of services that (on paper) are already being offered
prohibitive costs
lack of efficacy of AOT
too few patients would be eligible
I disagree with all four of these premises:
Clearly sufficient services to these patients are not being offered. While CCT, Regional Services, MRT, CIT, SUD, CCRC are good programs, they clearly are NOT providing sufficient treatment to most of the most severely ill patients unless the patients are lucky enough to be on LPS Conservatorship. One example: DHHS lists "Permanent Supportive Housing" as one of the services they offer but as you see above, the "supportive housing" being "offered" is shelters, cheap motel rooms and unstaffed Clean and Sober houses.
DHHS contends that the expense of implementing AOT would include more administrative, Court, attorney and clinical staff etc and cost DHHS over $550,000 per year and that they can't afford that. It is my opinion that the figure is vastly over estimated. Most of these patients are already utilizing services of the public defenders and the Court (and the county could bring back a MH court to efficiently and humanely administer these services). Even if the $550,000 figure is accurate, the county spends millions of dollars every year on administrators and other staff who do not provide actual treatment and DHHS and BOS are responsible for administering psychiatric treatment to these patients
AOT has been demonstrated in research studies in CA to be therapeutic, humane and to reduce hospitalizations and incarcerations. I disagree with the DHHS contention that AOT is not effective. AOT has actually been demonstrated to SAVE money for the counties that offer it.
As stated above, it is my opinion that there are MANY more than 4 patients who need and are eligible for AOT. (See paragraphs 3 and 4 above).
The BOS and DHHS administrators have NO excuse for not treating the patients they are legally mandated to treat. The BOS and DHHS administrators have NO excuse for not knowing (if they don't) their responsibility to these patients and to our entire community. The BOS and DHHS administrators are NOT using public funds appropriately. The BOS and DHHS should be AUDITED in order to determine how public funds are being spent by DHHS.
Finally, I can only assume that none of you have a family member suffering from severe psychiatric illness in Humboldt county or (hopefully) you would understand and take your responsibility to treat them seriously. I have evaluated many homeless mentally ill adults in Humboldt county who live in abhorrent conditions including camping without food, clothing and shelter, eating insects for food, suffering infections and wounds (such as severe blisters) and infestation by lice, believing that their loved ones have been replaced by imposters, trading sex for shelter, drugs and food etc. I hope you all recognize that by not offering adequate treatment (as you are all being paid to do), you have all contributed to some of the worst (and preventable) MH tragedies in our community. If you do not immediately audit how the funds are being used and improve treatment to patients with anosognosia you (Humboldt County Supervisors and DHHS administrators) also partly to blame for future tragedies. I would hope that you wouldn't want to live with yourselves if you don't do everything you can to adequately treat our fellow human beings and their loved ones. I would also hope that you would resign and never again take jobs in which you are responsible for life and death.
Sincerely,
Jennifer Katy Wilson MD
Related posts:
https://johnchiv.blogspot.com/2021/04/while-im-sure-it-is-uncomfortable-to.html?m=1
https://johnchiv.blogspot.com/2021/04/just-in-last-year-we-have-had-several.html?m=1
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