Health Care

State to decide fate of Rutland Mental Health as problems with management, services become clearer

Officials from Rutland Mental Health Services answer questions from a Department of Mental Health stakeholder committee about their agencies re-designation June 26, 2015. From left, Dick Courcelle, interim-CEO; David Long, VP clinical services; and John Stewart, CRT director.
Officials from Rutland Mental Health Services answer questions from a Department of Mental Health stakeholder committee about their agency’s re-designation June 26, 2015. From left, Dick Courcelle, interim CEO; David Long, vice president of clinical services; and John Stewart, CRT director.
Among the problems Rutland Mental Health Services must address to remain one of the state’s regional human services contractors is management of a waiting list for adolescent mental health services, a state report shows.

Within the past year a 13-year-old girl took her own life after waiting almost six months to get into mental health treatment at the agency.

The state is reviewing whether Rutland Mental Health Services should keep its status as a designated agency. RMH is one of 11 designated agencies, nonprofits that receive exclusive contracts for mental health, developmental disability and substance use services. The agencies receive more than $300 million from the state each year. RMH receives more than $28 million.

Stakeholder committees made up of clients, family and experts voted on June 26 to place the agency on provisional status with intent to de-designate. That’s a bureaucratic specification one rung below a recommendation that RMH lose its designation altogether.

The state must make a final decision on whether the agency should keep its designated status by July 28. If the state accepts the stakeholder committee recommendation, the agency will have a month to write a plan for improvement and six months to implement it.

Hostile work environment

The June 26 meeting was stakeholder committee members’ only opportunity to question RMH officials about the agency’s shortcomings. Discussion focused on a hostile and retaliatory work environment that led former CEO Dan Quinn to resign under duress earlier this month.

Dan Quinn, former CEO of Rutland Mental Health Services. Courtesy photo
Dan Quinn, former CEO of Rutland Mental Health Services. Courtesy photo

At a meeting with state officials in May, RMH employees shared an “outpouring of commonly shared” frustration about negative work culture that Frank Reed, Department of Mental Health interim commissioner, described as “unprecedented” in minutes from a previous stakeholder committee meeting.

Officials from RMH said at the June 26 meeting that Quinn’s resignation and their cooperation with the state has improved morale and will ultimately allow them to provide the level of service that’s expected of them.

“One of the things that we’ve learned about serving our clients is they need to feel safe before they can begin working on anything else, and the same holds true for employees. They have not felt safe, and I think that they do now,” said David Long, vice president of clinical services.

Long is set to retire in the near future, which he said was planned and unrelated to the agency’s current problems. Longtime CFO Tom Pour is also expected to retire soon.

Some members of the committee said they were cautiously optimistic that RMH was on a path to improvement, while others were skeptical Quinn’s ouster could be a panacea for an organization facing serious challenges, including high turnover and low morale.

Designated agencies’ struggle to offer competitive wages can drive turnover, but at RMH that was exacerbated by a destructive work culture.

“Our human resource department was decimated,” said Michael O’Brien, director of crisis and adult inpatient services, adding that a service quality director also recently left.

Wait list for children

Notably absent from discussion between the stakeholder committees and RMH officials, or the stakeholder discussion before voting, were the wait times for children to receive mental health services.

Cinn Smith is a member of the Department of Mental Health stakeholder committee and also a member of a standing committee created by RMH to provide oversight of its children’s mental health program.

Smith said she was shocked to read in VTDigger that a young girl died while waiting to receive treatment from RMH last year, and that the wait list for children, youth and families was not being well managed.

“That’s not what we were told” as members of the RMH standing committee for children’s mental health, Smith said. Anecdotally, she has heard from people in the community that families are still waiting too long to get their children into treatment.

“I’m hearing months,” she said. RMH officials would not answer VTDigger’s questions about the wait list for youth mental health services following their meeting with the standing committee.

Fear and retaliation

Getting accurate information to entities providing internal oversight at RMH appears to be a recurring problem. Smith’s experience on the RMH standing committee is one example. Another is that until the state’s increased involvement this spring, RMH employees weren’t allowed to speak with board members, according to a state report.

A letter from a former employee to members of the board obtained by VTDigger shows there was a culture of fear and reprisals dating back to at least 2011. The former employee circumvented management’s prohibition on employees speaking with board members to share his reservations about Quinn.

He was fired within days of board members acknowledging receipt of his letter.

In that letter, the former employee describes Quinn as uninterested in the agency’s work.

“He does not care about our consumers; in fact, he is quite uncomfortable around them,” the ex-employee wrote. Quinn was also domineering and administered retaliatory discipline that cowed other dissatisfied employees into silence, according to the letter.

The former employee was asked by a former manager if he would get a challenging and expensive certification for a specific type of disability screening. The former employee reluctantly agreed as long as he was given a raise to compensate for the added workload and responsibility. The manager agreed, but left the organization shortly after.

When the former employee went to Quinn, the ex-CEO asked him to take a pay cut in addition to conducting the new screenings. After refusing, the former employee was disciplined and RMH continued to contract for the service, despite having paid for his certification.

Quinn’s unwillingness to approve a raise was actually costing RMH more in contracting fees, according to the former employee. The former employee said he was aware of at least three other employees who were promised something by mid-level managers that Quinn later quashed.

The former employee’s letter appears to have had little impact on the board’s view of Quinn. Minutes from a July 2014 board meeting show they approved a raise for Quinn when he was already making more than $200,000 in total compensation. At the time Quinn was a voting member of the board, but minutes don’t reveal whether he recused himself from voting on his own raise.

The minutes show the board approved a 1.6 percent raise for Quinn, versus a 2 percent or greater raise for the rest of staff, depending on if, and how much, the Legislature increased Medicaid rates. The rates weren’t increased, but the decision shows how RMH planned to use the money.

Changes going forward

The board will no longer be insular from employees, and the CEO won’t be able to exert the same level of control as Quinn, officials said at the June 26 stakeholder committee meeting. Its bylaws no longer allow the CEO to be a voting board member, and the state has indicated that going forward board membership must draw from parts of the county outside the city of Rutland.

Employees will be given an opportunity at the start of board meetings to voice opinions or concerns about how the agency is operating. Current Board Chair Chris Keyser gave workers his cellphone number, an RMH official said. It will take time to rebuild trust, said RMH interim CEO Dick Courcelle, but the agency is committed to improving.

The state’s involvement with RMH has steadily ramped up over the last year-and-a-half as problems became more acute and may have led to some clients being abused or neglected.

Several members of the stakeholder committee wanted to know why RMH had only recently begun to take substantive steps toward improvement. Courcelle responded that he did not know.

That a climate of reprisals and fear permeated a critical — and largely publicly funded — social service agency for at least four years, if not Quinn’s entire eight-year tenure, raises serious questions about the designated agency system as a service delivery model for the state, officials say.

No agency has ever lost its designation. State officials have said they prefer to work with troubled DAs rather than creating a service void by pulling the plug on funding.

But because RMH could lose its designation, Barber, the DMH attorney, said the state will begin contingency planning. It’s unclear what organization in Rutland County or elsewhere could step in and serve Rutland Mental Health’s more than 3,000 clients.

Rutland Regional Medical Center is already offering support. The hospital’s director of psychiatric services is working with clinical staff at RMH, because he said the hospital recognizes the agency’s importance to the region’s system of care.

It’s unlikely, however, that the hospital could step in and provide all of the community support services Rutland Mental Health provides to the region’s most vulnerable, officials say.

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Morgan True

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  • Morgan True wrote, in part (paragraph 7):

    […] Frank Reed, Department of Mental Health commissioner, […]

    Unless something has recently changed unbeknownst to me, it is my understanding that Frank Reed is actually *acting* commissioner for the time being and a new DMH commissioner has not yet been officially appointed and name.

  • Dave Bellini

    These “designated” agencies have no performance guarantees, little oversight and they know there is no consequence for failure.

  • gail h johnson

    This is a troubling read about a $28 million dollar a year state agency in Rutland whose 3 thousand clients have been and probably still are adversely affected by gross negligence from its local leadership. It appears the negative climate and intimidating authority have been around for nearly four years before the state took appropriate measures earlier this year. I’ve served on several local boards of state agencies elsewhere and know local boards have a tough job balancing state directives with local staff agendas. Local board oversight is critical in this scenario or chaos erupts. Board ignorance followed by board inaction over several years would not a defensible plea in a situation like Rutland’ s. Boards members must shoulder significant due diligence. Was that at fault here as well?.

  • Rita Phelps

    Well I for one can tell you that the Agency of Human Services has certainly created a feeling of intimidation that is unprecedented in my experience as an advocate. Never have I ever seen Case Managers initial reports to the agency and APS given to the press with the mandated reporters name on the bottom of the document. I understand the Agency gave these documents to the journalist after a FOIA request. However never did the Agency seek a Court Order to protect the individual’s in their care, or consider their HIPPA Privacy. These were vulnerable adults whom had rights to privacy and those rights were not protected in any way, nor was the identity of the reporters, as was clearly the intent of the legislators whom fashioned protections under Title 33. Now as a mandatory reporter I feel that any mandated report I am forced to file to comply with the agencies policies, will be printed on Vermont Digger and subject to the agency being disciplined for, or losing it’s designation because that report was filed. So if the State thinks that it has created a safe atmosphere it really need to rethink that position. In my opinion, employees and the individuals served appear to be disposable in a political fight over the quality of services able to be provided given this State’s Medicaid reimbursement rate. There have been some very serious problems at DMH in Montpelier, and they are working under some very serious circumstances created by an incompetent uncaring attitude by this governor, whom seems to have no grasp of Medicaid reimbursement rates and how they impact services at designated agencies, hospitals, and private insurance companies.

  • Kristin Andrade

    When people ask me what I did while I worked at RMHS/CCN as the Children’s Coordinator many years ago, I simply stated that I managed waiting lists for services. The stories I have are vast, but simply put this is how it worked. This is the story I have told many times as a college professor, community member and longtime advocate for social justice.

    We would have clients come to us in varying need. We would schedule them for a psychiatric appointment so we could bill their insurance and then the cases would be open to me while they waited for respite, case management, and counselors to be assigned; a process that could easily take 6 months to a year. As the clients deteriorated without treatment and parents called me in crisis, I would advocate in team meetings and try to prioritize people’s needs. When I would suggest that therapists work after 4 PM as children were in school, parents were working jobs with no vacation or sick time to use for appointments when the therapist had availability, I was dismissed. I was told that it wasn’t safe for staff to be alone in the building that late at night (I was thinking several therapists would be there, but I never got that far). When I advocated that therapists work on weekends and have two week days off, I was ridiculed. When I pointed out that children in mental health crisis with no supports, living in poverty with undereducated, overwhelmed, sometimes in violent, drug ridden neighborhoods were probably in more danger, I was simply dismissed. Leadership didn’t care, didn’t want to problem solve or think out of the box to do so. I always say that RMHS WAS the box.

    Then our Community Mental Health Center could advocate at a state level that they had massive waiting lists, their services were in dire need and that the state of community mental health need was great; they continued to get the state and local money to manage waiting lists, not provide services and to give the CEOs a free house, big salaries and no raises for staff. They simply did not want to deliver the services when people could access it.

    It is certainly still unclear how the Board of Directors (BOD) knowingly did not respond to the glaring needs of the people they served, how they and other people in power allowed the CEO to not “allow” employees to attend BOD meetings (when they are open to anyone to attend by law since they take state funds), how the BOD has on it many prominent community people that also run our schools, colleges and city government or how state appointed and elected officials have known for the last 25 years that RMHS has not been an organization of integrity when it came to the treatment of employees, clients or partners and did nothing.

    Doug Racine advocated de-designating all the CMHCs when he first became the secretary of the Agency of Human Services, but quickly backed down when agencies balked. It would now make perfect sense to de-designate RMHS and allow others to bid for performance based contracts. To say that clients would be left without services is ridiculous. Many other extremely capable organizations like Easter Seals of Vermont, the Vermont Achievement Center, the Parent Child Center, ARC, etc… are more than capable, and have shown they are many times over, that they could provide the services. If you want to make RMHS better, par it down, dismiss middle managers that are also complicit, make it efficient at managing less services so they can learn how to provide them effectively and make it compete for contracts. The CEO has resigned, he dismissed the Director of HR last year, the CFO and Director of Quality & Risk Management are retiring soon. The timing is perfect for real change.

    The question really is, will Rutland have the guts to finally do it?

    The next BOD is at 7:30 AM on August 7th in the CAP Conference Room 100 B.