MINUTES

 

STATE OF NORTH CAROLINA BOARD OF COMMISSIONERS

COUNTY OF HENDERSON OCTOBER 26, 2006

 

The Henderson County Board of Commissioners met for a special called meeting, Mental Health Workshop at 7:00 p.m. in the Commissioners' Conference Room of the Henderson County Office Building.

 

Those present were: Chairman Bill Moyer, Vice-Chairman Charlie Messer, Commissioner Larry Young, Commissioner Shannon Baldwin, Commissioner Chuck McGrady, County Manager Steven Wyatt, Assistant County Manager Selena Coffey, County Attorney Russell Burrell, and Deputy Clerk to the Board Terry Wilson.

 

CALL TO ORDER/WELCOME

Chairman Moyer called the meeting to order and welcomed all in attendance.

 

DISCUSSION/ADJUSTMENT/ADOPTION OF AGENDA

Commissioner Baldwin made the motion to approve the agenda. All voted in favor and the motion carried.

 

Commissioner McGrady moved to set a Public Hearing for Economic Development Incentives for Wednesday, November 15, 2006 at 11:00 AM. All voted in favor and the motion carried.

 

ISSUE UPDATES

Steve Wyatt, County Manager, explained that contrary to what was published in the paper we have not called a Public Hearing but a Workshop to hear several items and to get an update on the progress made at this point. Arthur Carder, the director of the Western Highlands LME was present. Mr. Wyatt explained that presentations would be heard by service providers. The Staff present received binders with proposals from each service provider. Each provider was allowed 8-10 minutes to address the board followed by questions from the Board.

 

WESTERN HIGHLANDS LME REPORT

Arthur Carder, CEO of Western Highlands, discussed the importance of acquiring the records from Mountain Laurel\ New Vista (MLNV) and getting them to the new providers.

1.                 Different records have to be released in different ways.

2.                 Substance abuse clients are required to sign for their record transfer.

3.                 Access is questionable to MLNV records after November 1, 2006.

4.                 Records must be maintained for 11 years after the case is closed for adults and 11 years after a child turns 18 years of age.

5.                 The MLNV is responsible per the State for paying for storage of those records so that they may be retrieved as needed.

6.                 IRON MOUNTAIN is the facility that will be storing MLNV records.

7.                 The responsibility of having records available falls on the individual business that created the records. The Attorney Generals office states that the files cannot be transferred. New providers must create their own records. They can receive a copy of MLNV records if requested by the patient.

 

There was discussion of:

1.                Transferring cases to new providers

2.                Verifying sufficient Doctor coverage possibility of gaps

3.                Doctors who are signing up may be utilized in several different counties

4.                Continue to need additional Psychiatrist

5.                Pharmacy Proposal PSC MedSupply, LLC

6.                Critical balance with funds available

7.                Location of offices for public information

 

Families Together has withdrawn their proposal because the issues with the 6th Avenue Clubhouse were critical. They are, however, interested in providing services.

 

Western Highlands will give Steve Wyatt an update in regards to numbers that different affiliates should expect of calls or new clients.

 

Board discussion followed.

 

Appalachian Counseling

Polly Penland presented the proposal for Appalachian Counseling with several changes:

  • Startup costs for new staff
  • Startup costs for additional space (equipment, phone system, etc).
  • Total request for 2006-2007 $80,000

Services the organization is proposing to provide:

     Mental Health Therapy

     Psychiatric services

     Substance abuse counseling

     Community Support

Board discussion followed.

 

Blue Ridge Community Health Services

John Snow presented the proposal for Blue Ridge Community Health Services as follows:

  • Employment of one Licensed Therapist
  • Total request $49,450

Services the organization is proposing to provide:

     Outpatient adult behavioral health services provided by a licensed therapist in a family practice/integrated medicine setting

 

Board discussion Followed.

 

Community Health Network

Anne Marie Lester presented the proposal for Community Health Services as follows:

  • Personnel and fringe benefits
  • Supplies
  • Training and travel
  • Office Space
  • Information system
  • Total request $165,340

Services the organization is proposing to provide:

     CHN Integrated Care Program

     Therapeutic Services

     Case management

     Psychiatric services

 

Board discussion followed.

 

Horizon Recovery Inc.

Paul Kessler presented the proposal for Horizon Recovery Inc. as follows:

  • Start-up of new services, office space, if we are not offered space in the old public health building and payroll for new staff.
  • Total request $140,571

Services the organization is proposing to provide:

     Presently providing Diagnostic assessment; SAIOP Adolescent-Adult; Community support Adult (MH-SA) Intend to move our Henderson County Act Team from Asheville to Hendersonville.

     New Service: Community Support Children/Adolescents (MH-SA)

     New Service: Mental Health Day Treatment Child/Adolescent

     We have 16 hours of child psychiatric time but have been unable to recruit a licensed master child specialist.

     We are presently serving 62% IPR and 38% Medicaid.

 

Board discussion followed.

 

Mainstay, Inc.

Tanya Blackford presented the proposal for Mainstay, Inc. as follows:

  • Bed space
  • In-house Mental Health Counselors/Social Workers
  • Contract for Mental Health Diagnostic Services and Medication
  • Contracted substance abuse specific service providers
  • 24 hour crisis line, 24 hour on call in house mental health response
  • Total request $25,000

Services the organization is proposing to provide:

     Mental health/substance abuse services for families experiencing domestic violence and homelessness as related to domestic violence.

     Community Support Services as defined by New Vista/Mountain Laurel and shelter services for up to three months with the potential for individuals and/or families to access three additional months of transitional services.

 

Board discussion followed.

 

Providence

Michael Fidgeon presented the proposal for Providence as follows:

  • Relocating the adult services staff.
  • Relocating the adult medical services.
  • Rearranging and reconstructing space in order to accommodate both children and adults in the same building.
  • Moving or copying 2100 active client records.
  • Relocating a multitude of closed records.
  • Purchasing the additional supplies relevant to these tasks.
  • Coordinating services with and providing timely information to clients, schools, the Department of Social Services, local hospitals, law enforcement, the Health Department and several other community partners with whom we work closely.
  • Increasing the availability of staff in order to maintain medication needs and crisis prevention.
  • Establishing a new MIS system for clinical and billing data.
  • Transitioning centralized back office support functions (accounting, payroll, AP, AR, HR, billing) to FPSs customer support center.
  • Training, orientation, and re-organization of existing New Vistas staffing infrastructure under a new leadership model and operating paradigm.
  • Total request $500,000

Services the organization is proposing to provide:

     The maintenance of Effort funds will supplement the funds and efforts of the company and the staff to keep services flowing smoothly with the intent of preventing an increase in emergency room visits, encounters with law enforcement and the courts, and will help each client to experience comfort in the hands of familiar staff during the next few months of transition.

 

Board discussion followed.

 

Sixth Avenue Psychiatric Rehabilitation Partners, Inc.

Jacque Combs presented the proposal for Sixth Avenue Psychiatric Rehabilitation Partners, Inc. as follows:

  • Continuity of care for existing clients
  • Capital expenses
  • Equipment and support
  • Software
  • Vehicles
  • Startup cash flow
  • Total request $350,000

Services the organization is proposing to provide:

     Diagnostic Assessment

     Community Support

     Assertive Community Treatment Team (ACTT)

     Psychosocial Rehabilitation Program (PSR) Clubhouse

     Substance abuse and mental illness support groups

 

Board discussion followed.

 

Parkway Behavioral Health

Don Reeves and Blair Clark presented the proposal for Parkway Behavioral Health as follows:

  • Staff
  • Equipment
  • Space
  • Total request $20,000 start up + $4,500/mo on-going for psychiatric 24/7 ($74,000)

Services the organization is proposing to provide:

     Walk in centers for day time urgent/emergency services for unassigned clients

     Physician back-up coverage for day time psychiatric crisis

     Facilitate involuntary commitments by on-call clinicians/CS workers

     On-site assessments/discharge planning at Broughton Hospital

     Stabilizing services

 

Board discussion followed.

 

Free Clinics

Judy Long presented the proposal for Free Clinics as follows:

  • The request will cover the cost of supplies associated with the clinic, as well as some staff time necessary to coordinate and manage care.
  • Total request $21,000

Services the organization is proposing to provide:

     A new Psychiatric center

 

Board discussion followed.

 

PSC MedSupply, LLC

Steve Wyatt, County Manager, has negotiated with PSC. We have a commitment from them as of today to begin Wednesday, November 1, 2006 at 8:00 AM. They will provide the list of services outlined on hand-outs. We have secured appropriate space for them adjacent to the new Health Department. The staff will be outfitting the space during the day Tuesday just prior to opening Wednesday. The request for Board action is included. We do not have a written contract with them. The recommendation from staff is that the Board give Steve the authority to develop and execute the contract to facilitate a quick turn around. The County will be providing the space, heat, light, utilities, and internet access. PSM MedSupply, LLC will provide everything else including furnishings and staff. To facilitate this we will need the Board to take action tonight as described. Chairman Moyer stated that if the staff developed the contract the Board would sign it.

 

Commissioner Messer made the motion that the Board authorizes the County Manager and Staff to enter a formal contract with PSC to provide the services as discussed.

 

All voted in favor and the motion carried.

 

Continuation of Western Highland LME

Commissioner McGrady requested information pertaining to criteria from Arthur Carder. Mr. Carder explained that all providers presenting information today are hoping that they may receive funds. Most providers would be able to do a little less if they didnt receive the total requested, which means the gap gets a little bigger potentially in terms of what is currently out there. We are speculating what people think they can do at this point. The key obviously is looking at an array of services, not just one big provider to do everything. The key is numbers because we have an estimate of 2000 people that we need to make sure services are provided for. Who has the capacity to respond and meet the needs of people quickly? What are their track records and successes? You know where your money is invested and its going to give a return. This will be a difficult decision because there is a very limited amount of money available to address the needs.

 

Chairman Moyer stated that the requests exceeded $1,500,000. We have $520,000 which has already been set aside and allocated for mental health.

 

Recess

Chairman Moyer stated that a break would be taken and then discussion would start back up. They may have additional questions for the presenters.

 

 

Reconvene

Chairman Moyer called the meeting back to order.

 

Chairman Moyer stated that the Board was going to have a tough decision based on the amount of money that is available to spend and the amount of requests. He again thanked the group for all of their presentations, patience, and requests. He informed Steve Wyatt that the task of narrowing the decisions down now had to be made and asked if he had any suggestions. Mr. Wyatt replied that all proposals were excellent and that the decisions would be difficult. Staff is using past lessons learned. Cast a wide net and dont have all your eggs in one basket. We have limited resources. He didnt recommend that all funds be allocated tonight. Leverage the County funds and look at this action tonight as an investment in start up or seed money to facilitate capacity to development. We need to make an investment and partnership with those who have been doing a lot of the heavy lifting and have those past track records. At this date and this time and this situation how can this Board act to make a difference and make the best decision ultimately for the consumer of this service? Whatever decision made would obviously not be a perfect decision. We cannot provide a scenario where every person has the ideal service. What we have to do is make the best decision we can make with the information we have available. This also points toward holding some of the funds in reserve. We also need to give some consideration to the worst case scenario. Looking at a worst case scenario such as mental health playing a role in domestic violence where innocent folks get hurt. We have heard a very cost effective proposal there. Filling in the numbers and deciding how to spread the money around is difficult.

 

Commissioner Baldwin stated that we needed to look at priorities. He doesnt feel that he has adequate information.

 

Commissioner McGrady shared the hesitancy with Commissioner Baldwin. He also doesnt feel capable of figuring out which is the best with the current information.

 

Commissioner Messer also agrees but realizes we have to make a decision because we are at a critical standpoint.

 

Commissioner Young also agrees however he needs more time.

 

Chairman Moyer feels that the Board had adequate time to research the information and that they need to make a move and recommendation now. There is no time and it is not necessary to move this to staff and have them make a recommendation.

 

Arthur Carder reminded the Board that we are in a crisis situation. Everyone is not going to be happy. We all know that whatever decisions the Board makes are decisions that you are making in the best interest of this county. Everyone will respect that. We know that they are not going to he perfect decisions. There are going to be weaknesses with them. The providers understand that and they know that you are not going to be able to fund all these things. I would encourage you to struggle with making an imperfect decision. There is a wide variety of proposals and you must make your decision on information you have read and your own gut feeling about where you need to go from here.

 

Commissioners decided that the Chairman could lead them through a process and if they dont have a consensus at the end of the meeting then they could step back and give it one more day. Chairman Moyer reminded the commissioners that Wednesday is a critical day and in all fairness the presenters need an answer so that they can move on.

 

After elaborating Chairman Moyer proposed the following recommendations.

 

       The Free Clinic $ 21,000

       Sixth Avenue West Clubhouse $ 100,000

       Mainstay $ 20,000

       Community Health Network $ 75,000

       Horizon Recovery $ 75,000

       Appalachian Counseling $ 50,000

       Blue Ridge Community Health Services $ 40,000

       Providence\Division of Family Preservation Services $ 0

       Parkway Behavioral Health $ 10,000

 

Total Allocated $ 391,000

 

Reserve $ 137,342

 

Chairman Moyer expressed that the Board should look at where each presenter is in a couple of months to see what they had accomplished.

 

Commissioner Baldwin made a motion to approve the list as presented by Chairman Moyer.

 

Chairman Moyer recommended that the Board approve the list.

 

Four voted in favor and one voted against and the motion carried. Bill Moyer, Shannon Baldwin, Charlie Messer, and Larry Young voted for. Chuck McGrady voted against.

 

CLOSED SESSION

Commissioner McGrady moved that the Board go into closed session pursuant to North Carolina General Statutes Section 143-318. 11(a)(5)(i), to discuss and give instructions on the Countys negotiating position concerning the purchase of real estate.

 

All voted in favor and the motion carried.

 

Attest:

 

 

 

 

Terry L. Wilson, Deputy Clerk to the Board William L. Moyer, Chairman