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Mother concerned that her developmentally disabled son is being lured into a dangerous ‘vacation’ in Mexico

April 19, 2017 10 comments

Kris Myerson’s 30-year-old son is both autistic and schizophrenic and has periodic psychotic symptoms.

The man, whose name we are withholding due to privacy concerns, is incapable of taking care of himself, Myerson says. While he has very high verbal skills, he can’t recite the months of the year in order, for instance, or find his way to their car in a mall parking lot.

Myerson said her son is certainly not capable of going on a trip by himself to a different town much less a foreign country. Yet, she said, her son’s Northampton-based residential provider, ServiceNet, is allowing — and may even be encouraging  — him to accept  what appears to be a suspicious offer from one or more persons she does not know to fly to Mexico and meet them for a “vacation” next month.

Myerson’s son apparently hooked up with this person or people while playing Xbox online.

Myerson said one of those people reportedly told her son that he or she will pay for him to stay for a month in a hotel in Cancun once he meets them at the airport there. Also, Myerson’s son told her the person promised to provide him with a “girlfriend” during his stay.

According to Myerson, staff at ServiceNet recently helped her son apply for an expedited passport to enable him to take the trip to Mexico, which is scheduled for May 17. The group home personnel also reportedly offered to give her son a house cell phone for his use on the trip.

There may be no legal way for Myerson to stop her son from going to Mexico since he does not have a guardian and is over the age of 18.

Yet Myerson’s son qualifies for services from both the Department of Mental Health, which funds his ServiceNet group home, and from the Department of Developmental Services. She says that neither state agency appears to be willing or able to stop the trip.

In an April 14 email, Julie Schwager, DMH western Massachusetts area director, stated to Myerson’s daughter that DMH could not apply for an emergency guardianship of Myerson’s son because clinicians in the department have not determined that the man lacks the legal capacity to make his own decisions.

But Myerson believes her son does lack that capacity and is afraid her son could be harmed in Mexico. He weighs about 123 pounds and is 5′ 11” and is emaciated, she said. At the very least, she fears he will get lost there.

In the past eight months, Myerson said, her son has been hospitalized for overdosing on Advil and for self-starvation and dehydration while in ServiceNet’s care.

Myerson applied in 2014 to be her son’s guardian, but was unsuccessful because her son reportedly contested her application and because DMH sided with her son and against her bid for guardianship.

DMH has in the past sought a state-appointed guardian for Myerson’s son — a move that Myerson supported. But the agency backed off that effort and the guardianship never took place for reasons that were never explained to Myerson. She thinks it is possible that her son contested that effort as well. He apparently doesn’t realize that he is in need of a guardian.

Lately, Myerson has been unable even to get any information from DMH or DDS about the status of her son’s planned trip.

In an April 11 email to Myerson,  Schwager said that the agency’s authorization to talk to her about her son had been revoked. Without specifically mentioning the Mexico trip, Schwager added that, “Although it may be of little comfort, what I can say is that DMH works very closely with its providers in situations that we are concerned about to mitigate any potential risk.”

Myerson said she doesn’t understand why DMH is now saying its authorization to keep her informed about her son has been revoked. She maintains that her son never signed such an authorization in the first place, and yet DMH officials routinely communicated with her up to now about her son.

Myerson said her son recently asked that she become his representative payee for his Social Security disability income. For that reason, she said, she told Schwager that she needs to know what financial arrangements the group home may have made or is contemplating for her son’s trip.

In an April 10 email to Schwager, Myerson asked whether the money for the trip would be coming out of the group home’s funds or whether it would come from her son’s Social Security income.  However, that was the email to which Schwager said her agency’s authorization to respond had been revoked. As a result, Myerson has received no answer to that question.

Myerson said her son has about $1,000 in cash in his bank account and is expecting an $8,000 retroactive Social Security check.

I placed calls to Schwager yesterday and to the office of Daniel Lunden, DDS Central West regional director. The calls weren’t returned. I did talk to Daniela Trammel, DMH director of communications, who said the agency could not comment on the case.

A poor track record of care

Although ServiceNet personnel may consider themselves to be supportive of her son’s wishes, Myerson maintains that the agency is abetting him in potentially self-destructive behaviors. She contends the agency has a track record of making decisions like that concerning her son.

Myerson said that a couple of years ago, her son was initially placed in a ServiceNet group home in Greenfield where he was not given needed behavioral medications. He had a compulsion to injure himself, including burning his arms and other parts of his body with lighter fluid, and often went missing from the residence. She said ServiceNet failed to seek treatment for her son’s burns and allowed him to go for long periods without showering or changing his clothes.

A major police episode resulted after her son apparently purchased a knife at a Walmart in New Hampshire in May of 2015, using a credit card that a staff member at ServiceNet had given him. Myerson, who was with her son at the Walmart at the time, was unaware he had purchased the knife in the sporting goods section of the store until she was informed of it by a cashier. She said she was afraid to confront her son about it, but instead reported the matter to ServiceNet and to DMH.  But she said DMH refused to take the knife away from her son.

A week later, she said, she got a call at 1 in the morning that her son had been arrested for stabbing someone.  He was charged with attempted murder even though the person he stabbed was not severely injured and had actually attacked her son first. Her son was found innocent by a jury.

Myerson said her son had also had a prior criminal charge for biting a police officer’s finger during choke hold. He pled guilty and was placed on probation as a misdemeanor. He was sent to his current ServiceNet group home after having spent a year in the Worcester Recovery Center, a DMH hospital in which he badly decompensated. His probation reportedly ends next month, allowing him to leave the country at that time.

At the very least, we believe DMH clinicians should revisit their assessment of Myerson’s son’s mental and legal capacity to make his own decisions and consider filing for an emergency guardianship. We see no sound basis for this man’s decision to take this trip to Mexico and are troubled by the state’s apparent lack of concern about the situation.

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MassHealth audit casts doubt on claimed savings in privatizing state services

April 4, 2017 1 comment

Last year, State Auditor Suzanne Bump approved a proposal to privatize mental health services in southeastern Massachusetts after the for-profit Massachusetts Behavioral Health Partnership (MBHP) claimed it could save $7 million in doing so.

The auditor’s review under the Pacheco Law required Bump’s office to compare the proposed costs of privatizing the services with continuing to carry them out with state employees in the Department of Mental Health.

In a report released yesterday, the auditor maintains that MassHealth, the state’s Medicaid administration agency, made questionable, improper, or duplicate payments to MBHP totaling $193 million between July 2010 and 2015. Those allegedly improper payments appear to have been made under the same contract with MBHP that served as the vehicle for privatizing the mental health services last year.

Under that umbrella contract, known as the Primary Care Clinician Plan, MassHealth paid MBHP more than $2.6 billion between 2010 and 2015.

Given the finding that MassHealth’s total payments to MBHP include $193 million in questionable, improper, or duplicate payments, it would seem it has just gotten harder to argue that privatization of human services has been a great deal for the state.

In fact, it seems possible that one of the reasons MBHP was able to offer bids from two providers for privatizing the mental health services that were $7 million lower than what the state employees could offer was that the company knew it could more than make the money back in duplicate payments from MassHealth.

A description of the MBHP billing arrangement by the state auditor paints a picture of the company as a middle-man between MassHealth and providers of actual services under the Primary Care Clinician Plan (PCCP) contract.

According to the audit, the Commonwealth pays MBHP a fixed monthly fee under the PCCP contract for each member enrolled in MBHP.  MBHP then “recruits and oversees networks of third-party direct care providers who assume responsibility for providing a range of covered behavioral-health care.” MBHP subsequently “pays the providers using the monthly…premiums received from the Commonwealth.”

MBHP’s real role here appears to be as a pass-through of state funds. What MBHP really seems to add to the process is an apparently large layer of bureaucracy.

We have noted that MBHP is a politically connected company whose parent companies manage the behavioral health benefits of  70 percent of MassHealth members.  In April 2015, Scott Taberner, previously the chief financial officer at MBHP, was named Chief of Behavioral Health and Supportive Care in MassHealth.

As we pointed out, Taberner was put in a position to manage the contract with the company he used to work for.

State employee unions, including the Service Employees International Local 509, the Massachusetts Nurses Association,  and the American Federation of State, County, and Municipal Employees Council 93 did challenge Bump’s initial approval of the privatization arrangement with MBHP last year for the southeastern Massachusetts mental health services.

The unions maintained that the lower bids submitted for the privatization contract assumed major cuts in staffing at mental health facilities in southeastern Massachusetts, which would be likely to result in lower-quality services. They argued that the Pacheco Law requires that service quality not be affected.

The Pacheco Law requires a state agency seeking to privatize services to submit to the state auditor a comparison of a bid or bids from outside contractors with a bid from existing employees based on the cost of providing the services in-house “in the most cost-efficient manner.”  If the state auditor concurs that the outside bidder’s proposed contract is less expensive and equal or better in quality than what existing employees have proposed, the privatization plan will be likely to be approved.  If not, the auditor is likely to rule that the service must stay in-house.

In December, the state Supreme Judicial Court upheld Bump’s Pacheco Law review.

An SEIU official said to us yesterday the union is reviewing the auditor’s latest audit. We think that at the very least, the audit calls into question the savings claim in privatizing the southeastern Massachusetts mental health services.

More broadly, the audit of the MassHealth-MBHP contract calls into question MassHealth’s system of internal controls in managing state’s $13 billion Medicaid program.

It appears the MassHealth internal control system is so inadequate that the administration was unaware that hundreds of millions of dollars in improper payments were being made to its major contractor. Yet the administration was eager to reward MBHP’s efforts to eliminate state employees and cut staffing for mental health services in order to save a reported $7 million.

The MassHealth-MBHP debacle should serve as a warning to legislators and others that privatizing state services is not an automatic panacea to problems in service delivery and to high costs. Privatization comes with potentially high costs of its own, particularly when the state forsakes its role, as it appears to have done in this case, of adequately managing and overseeing its contracts with service providers.