FREE KEVIN WALSH

Judge orders fast action on mental-health system

Jodie Snyder
The Arizona Republic
Oct. 9, 2004 12:00 AM

Repeatedly chastising the state for poor monitoring, a Maricopa County Superior Court judge on Friday ordered it to come up with a plan to fix the Valley's mental-health system by mid-December.

Judge Pro Tem Bernard Dougherty told the state to return in two months with a detailed report on how it will comply with court orders under the Arnold vs. Sarn case, which is more than two decades old.

A stern Dougherty spent most of the three-hour hearing pointedly questioning why the mental-health system is still failing.

He also ordered the Arizona Department of Health Services to provide much-improved services at five clinics as an interim step.

The judge did not spell out what will happen if the state doesn't comply, but options range from being held in contempt of court, sanctions or a court takeover of the mental-health system. In the 1990s, the Arizona Supreme Court threatened to cut off school funding unless lawmakers eliminated disparities in how school construction was funded.

During the hearing, Dougherty said he got the Arnold vs. Sarn case in 1983 and decided to continue overseeing even though he retired in 2001.

"I want to be able to go to my grave knowing this has been resolved . . . and I intend for that to happen," he said.

Arnold vs. Sarn is a class-action lawsuit that was filed on behalf of patients who weren't getting mental-health services from the state. After years of negotiations, the state agreed to provide certain levels of care.

An August audit ordered by the court showed system problems nowhere close to being resolved.

The judge called Friday's hearing after receiving the audit. He called the results "shocking and abysmal."

In fact, about 85 percent of people with a serious mental illness in Maricopa County don't get needed services. ValueOptions serves more than 50,000 clients, 16,000 of whom are seriously mentally ill.

The lack of services comes despite getting $230 million in extra funding and being under court order.

"The last four years didn't show any progress, only retreat," Dougherty said, enunciating every word for effect.

He was especially critical because six years ago the state told the court it would provide certain levels of care, which it is nowhere close to providing.

"The court orders and findings are not aspirational. They are mandatory," he declared.

During the hearing, Dougherty zeroed in on Leslie Schwalbe, deputy director of the state health department. Schwalbe is in charge of behavioral-health services.

"What happened?" he demanded of her.

Schwalbe said the state had been busy following federal standards.

"But you were under specific court orders," the judge shot back. "You were given deadlines . . . and it didn't get done, did it?"

Dougherty also questioned the state's attitude toward ValueOptions, a for-profit company hired to manage and provide mental-health services.

Schwalbe said the state considered ValueOptions a partner. "In hindsight, we need to be much, much more regulatory in our approach," Schwalbe told the judge.

At one point, Dougherty asked Schwalbe if the state should be like Donald Trump of The Apprentice and say, "ValueOptions, you are fired."

State officials said there are provisions to get out of the contract, if necessary.

Ronald Dozoretz, head of ValueOptions' parent company FHC Health Systems, said he realized that the company's contract, like all government contracts, is not permanent.

Dougherty said he was moved by mental-health clients and advocates who spoke at the hearing.

Tom Kelly told him about living in his car and waiting to get into a homeless shelter. ValueOptions told him that he was too unstable to go to a homeless shelter. Then Kelly asked to be hospitalized because of his instability; within hours, he was placed in a homeless shelter.