Oregonian Editorial – Meltdown reveals wider lapses

From the Oregonian, July 11 2008

Chairman Ted Wheeler must redesign mental health services, while maintaining them and increasing the county’s vigilance

What an incredible gig. Imagine living in France for two years while drawing a full-time salary for a nonprofit based in Oregon.

It may rank among the Top 10 Telecommutes of All Time.

Jeff Poolin [Poulin – pictured right] worked for Cascadia Behavioral Healthcare, the state’s largest mental health agency, as its chief information officer. The information Oregonians probably want from Poolin [Poulin] right now, though, is: How in the world did he pull it off?

The answer is that Cascadia was willing to make such an arrangement with him because it was very dependent on him; he apparently understood the agency’s computer system better than anyone else. And this spring Multnomah County discovered, in similar fashion, that it was far too dependent on one mental health agency, namely Cascadia.

That agency’s financial meltdown in April left the county and state rushing in with a $2.5 million rescue to cushion the transition for thousands of patients — 2,500 in Multnomah County alone. The county has made the health of patients its first priority, although at least one of the county’s choices might make that hard to believe.

Picking the Garlington Center in Northeast Portland for closure was a bad idea, and the county should have been able to figure that out long before protesters mustered 40 pages of signatures against the closure.

If that choice made the county look out of touch, being out of touch seems to be an emerging theme for Multnomah County. Recently, in fact, we learned the Cascadia meltdown, and the county’s failure to detect it, was not necessarily the aberration it seemed. A county audit, released this week, shows Cascadia fits into a frightening pattern of county inattention.

One of the county’s core functions, remember, is to monitor contracts with a multitude of social service agencies. A lot of money goes into those contracts, about $276 million. What the audit showed, scary as it sounds, is that the county runs most of these contracts the same way it ran the Cascadia one — via remote control. “There is absolutely every risk that the kind of situation that happened with Cascadia could occur again,” auditor LaVonne Griffin-Valade told The Oregonian’s Arthur Gregg Sulzberger.

The county, understandably, likes providing services to real people better than monitoring contracts. But, as the Cascadia saga makes painfully clear, you can’t really separate the two. When an agency is in financial turmoil, that winds up jeopardizing services and ultimately the safety of patients, as well as the trust of taxpayers.

In the past 12 years, the county’s mental health division has been through at least two redesigns, announced with some fanfare. Eleven leaders, in eight different combinations, have run the division. What County Chair Ted Wheeler announced last month was less a redesign than a salvage plan, but Wheeler made it clear, in any case, that he didn’t expect it to be enough.

Wheeler, a mountain climber, now has a triple peak in front of him. As he doubtless knows already, he needs to redesign the county’s mental health services virtually from scratch, while continuing to provide adequate services. And he also must drastically improve the county’s supervision and monitoring. Essentially, the county has to redesign that, too.

None of this can be done via remote control.