This blog originally founded by Blogger who holds a theological degree and a doctorate in Counseling Psychology. Taught Psychology for 32 years and is now Professor Emeritus. Is a board-certified psychologist and was awarded the Lifetime Achievement Award in his profession. Ministered as a chaplain, and pastored Baptist and Episcopal churches. Publications cover the integration of psychology and theology. Served in the Army, the Merchant Marines and the Peace Corps.

Wednesday, December 7, 2011

Important and Accurate Letter on New River Debacle (In case local media do not carry it.)

To:  Alleghany, Ashe, Avery, Watauga and Wilkes County Commissioners, County Managers, County Finance Directors and County Attorneys  From Deborah Greene, Citizen of Watauga County and State of NC

I have reached the opinion that nothing has changed.
The NRSA (New River Service Authority) board is the same except for the replacement of the commissioner appointees with county managers. However, the county managers are responsible for lack of oversight of a subsidiary of their local governments. Only one county commissioner was removed from the NRSA board and that was Mr. Richardson.  All existing commissioners who had served on that board (past and present) should have been replaced. The NRSA board attorney should have been replaced.  Then their remains some other problems, the Wilkes County board depends on an attorney, Tony Triplet that served on the NRSA board from day one, drafted the 160A agreement and served as an officer of the NRSA board (served as Vice-Chair on the Executive Board).  The Finance Committee was comprised of commissioners only. There was a Governance Committee that was devised for the purpose of posturing for political control of the NRSA board. Kenny Poteat of Avery County was treasurer, received all bank statements and had signature authority; now he is chair of the NRSA board. Bruce Kaplan was the NRSA board attorney. The CEO resigned and the CFO resigned; the management team and executive management team is gone. The common thread remaining in the financial debacle is the NRSA board (county commissioners) and all oversight representatives (county managers and county finance directors).  The same governing board that allowed the demise to occur is still in power. If I could not find any evidence that the NRSA was apprised of the situation, I would not have a problem with that. However, the minutes demonstrate overwhelmingly that they were apprised every month from 1/24/2008 forward. They had Mary Deni, CFO; Amy Oliver, Interim CFO with Jack Parsons, Financial Analyst on board at $150 per hour; they had Ms. Mayo from Crisp, Hughes and Evans, LLP (prior auditors for NRBH New River Behavioral Health) with Jack Parsons on board; they had Larry Aggers with Ann Wilson, financial analyst and forensic auditor on board. How do I know this? Because it is in the minutes and they all gave presentation after presentation and offered options time and time again to address the issue.  Every month they were given an account of the operating losses for the month and the projected operating losses for year-end.

There is evidence that SMC tried to help NRSA;  not destroy it. However, there is one issue I see with SMC; (Smokey Mountain LME) they had the responsibility to monitor financial situation. There is evidence that they tried. And, the problem I see with this financial oversight requirement is that NRSA would point blame at SMC  and threaten to find another LME.  Legislation needs to be in place to require oversight of replacement of LMEs since the LME is to monitor and report financial and service issues (i.e. like auditors being replaced).  When a firm wants to replace an auditor, it usually is a red flag. The LGC has to approve auditors, audit contracts and dismissal of auditors. There needs to be the same with LME contracts. 

The dismissal of Mr. Richardson was appropriate. However, the reason may be an issue. If he was dismissed from the NRSA board because of his past participation and investigation pending, then fine.  However, he was dismissed, in my opinion, because he also serviced on the SMC board and he was acutely aware that SMC was not the problem as the CEO, CFO and staff attempted to assert. And, the NRSA board wanted him off.  Now, I question the appointment of commissioners to the SMC board. I don't understand how an LME with a contract with a service provider would also have representatives from the same service provider on their board. That would be like Martin Starnes & Associates, Inc. having commissioners from Wilkes County sitting on their board.  LMEs want county participation (rightfully so since they want to establish input in providing services to the areas they service); however, in the case of Alleghany, Ashe, Avery, Watauga and Wilkes, the counties are the contracting providers. The county representation should have been sought by application with no ties to employment with NRSA or county affiliation.

Some citizens question the SMC role and that is their right. I don't agree; but, I respect their right. And, with that question looming in the minds of citizens and commissioners, SMC's role should be part of the investigation. And, there may be some responsibility despite Mr. Ingraham's hesitation in disclosure when he first became aware of the situation.  I attribute his hesitation to the political nature of NRSA (5-county joint venture which is not the same as oversight of a for-profit or not-for-profit due to the egg shell environment of tentacles of Federal, State and Local Government).  At this point, every entity and person in place at the time is under investigation; that calls for suspension of the parties closest to the situation - governing board and management team of NRSA. The same group that is under investigation cannot hire someone to investigate themselves.

And, that brings me to Martin Starnes & Associates, Inc.  As auditors for 2 of the counties involved in the joint-venture (Alleghany and Wilkes) and Crossroad Behavioral (the other LME with which NRSA contracted LME services), they should be part of the investigation as should the county finance directors, county managers and auditors for all counties in the joint-venture). So, who is going to determine if the Wilkes County Finance Director and the Alleghany Finance Director or County Manager's liability insurance kicks in?  Who is going to determine if the liability insurance of Martin Starnes & Associates, Inc. is going to kick in? Martin Starnes & Associates, Inc.?

How is it that the same attorney, the same board members, the same treasurer, the same county managers, and one of the common auditors can have this all sewn up? Control of the outcome?  Protection of personal liability? Limit response to public that would diminish the responsibility of the counties (save face)?   However, they have missed every opportunity to curb damage control. The NRSA is in continual and willful violations of open meeting laws. They are not demonstrating that they are forthcoming with information to the other commissioners who are not on the NRSA board.   They think and/or allow their attorney to tell them they don't have to go back to their respective boards for approval. If they are not guilty of it; they give the impression of malfeasance.

County Manager, Don Adams of Alleghany, tried to sell me on the purpose of Martin Starnes & Associates, Inc.  He claimed that they had volumes of experience with working with service providers and LMEs and that they hired them to get answers for the citizens. To which I replied, why hire an auditor that has a conflict of interest if this is to get answers for the citizens. I told him that from a citizen perspective, not that it really matters, as I could see from their demonstration of non-transparency, that they were protecting themselves; this explains why he has now embarked on this mission of divide and conquer.  The NRSA never expected that the watchdogs from the counties and the news media would come together. They are so blind that they are not aware that it is the lack of transparency that has brought this unexpected situation upon them. The media is pushing back and the watchdogs are pushing even harder.  With the cooperation of the media, another unusual event as the media is usually duped into being the propaganda arm of the government, the media and the watchdogs are unraveling the debacle.  

How much is the NRSA paying Martin & Starnes, Inc. to read the minutes and them whether they knew about the situation? (How stupid does that sound?)  Bottom line and my observation for what it is worth - we need a Billy West type to dismantle this and get to the bottom of things.  All of the other commissioners need to read the minutes and hear from Ann Wilson, Lowdermilk Church & Co and SMC. And, it wouldn't hurt if they listened to Billy West's historical account of the industry and opinion. Now that the transition is over, he has nothing to lose. A presentation from him would dispel the rumors of his biased and conflicting relationship with SMC.  Of all of the people that I have observed, it is Mr. West that is most professional, most knowledgeable, honest, candid and unbiased. He embodies the definition of CEO.   His last letter demonstrates that his patience has run out and he has no further time to waste with incompetent pinheads who are politically motivated; he has a business to run and he doesn't want that business to be dragged into the mud with NRSA.

cc: High Country Press, Wilkes Journal Patriot, Ashe Mountain Times, Alleghany News, Jefferson Post


guy faulkes said...

Mr. Howell, what specific incidents have given you this opinion of Mr. West?

I assume you were speaking of him. It is not clear.

Anonymous said...

I believe Mr. Howell is speaking of Mr. Brian Ingraham the CEO of Smoky Mountain. The LME is the entity seeking the medicaid waiver.

guy faulkes said...

Well, Anonymous, the post certainly needs clarification as to the party Mr. Howell was referring to and why he feels that way.

Blogger said...

As an administrator of this blog obviously I am concerned if someone steps over a line and libels someone. The banner on our main page states “Don’t attack a private citizen by name.” From the comments above, we have the following:

The first commenter Mr. Howell made a strong statement about an unidentified person.

Uncertain whom was being targeted, the next commenter wrote: “Mr. West? I assume you were speaking of him. It is not clear.”
Which was then followed by: “I believe Mr. Howell is speaking of Mr. Brian Ingraham the CEO of Smoky Mountain. The post certainly needs clarification as to the party Mr. Howell was referring to and why he feels that way.”

Because it is never clear as to whom is being talked about, I have no way of knowing whether the person is a public figure or a private figure, I have therefore decided to play it safe and take the original comment down.

inquiring mind said...

Blogger. I agree. I have read a composition from the original commenter. It has actually been sent to all county administrative offices, State representatives and the news media. Because it has been sent to county administrative offices and State representatives, the composition is public information.However, just because it is public information doesn't make it not liable and it has every appearance of being liable. This was done to me about 10 years ago and a letter was sent to everyone who had received the letter from me telling them that any distribution of the letter to anyone else would be considered support and continuation of the originating liable action. I heard back from all parties stating that they understood the liable nature and had no intention of further publication of such letter.

Anonymous said...

The following was sent to me and was ostensibly written by a person who has commented on this blog. I have no way of verifying it but because it is obviously a concerned local citizen, for the time being, I will post it under Anonymous and because of space limitations it is in two sections. The person writes:

With regards to this mess we have in New River Behavioral Healthcare, here is MY OPINION as to what is happening right now. You may already sense that this is possible. I firmly believe that we are being taken for a ride by snake oil salesmen. Country boys and country ladies are easily conned if you come in looking like you work for IBM, have a large smile and a slick tongue and talk fast, rattling off a half-dozen organizational names, giving impressive numbers, using humor on occasion and telling them that it may be difficult, but not to worry they are here to do you a favor. Our mothers told us a long time ago to beware of strangers bearing gifts. And we forget. We have to remember that these guys are in it for the money, not because they are deeply caring people who want to help people. They are not missionaries. They know that if they keep supporting the LME guys every step of the way, they will get to the big times with them. Its just a matter of time. It is now obvious...its all about power, prestige and money. If you will check weekly across this 5 county program, you will no doubt find that staff are leaving. Local staff think that we will close here before January. They are offered jobs for half the pay. Others are being cut from full time to half time, or less. No one cares how many leave, or how many clients just get fed up and drop out. Its more money in someone's pocket. The hero and savior is this guy who is described best in John Cambell's book, THE PEOPLE OF THE LIE...super intelligent, very successful, super cunning, slick as greased lightning, but on a personal level, cold-hearted and dangerous. He will get to the top management trio in the State no matter how many people or programs he has to walk over to get there. He could sell freezers to Eskimos, but here in the mountains he is Elmer Gantry in "missionary come to Sparta" style and He has conned 5 county managers and 5 county commissioners into a game in which he knows the
language and he makes the rules. He has played this game many times before and he is good, very good. These 10 men are dangling on a string which he pulls at will, and these people have no idea what's going on. You can't crawl into the ring with men like him and expect to win. It doesn't happen. You've lost before you put on the gloves. And then we hire as the chief investigators the outfit that audits the books in Wilkes and Alleghany, and expect them to turn over every stone no matter where it is. You've got to be kidding.

Anonymous said...

And we end up with 5 sets of county governments worrying themselves sick and dreaming of flying somewhere just to get away, and you have a local population getting very angry that somebody has destroyed one of the best mental health systems in the State...the New River system that's been around for 40 years and has left the people of the counties to pay for the damage. Somebody, or a lot of somebodies better wise up quickly and get this thing settled...who destroyed it And who can fix it? And somebody needs to select another management group and another provider of comprehensive mental health services soon or the people of this county will get themselves another board and another manager who can do what is right and just. All we have now is hand-wringing, panic focused actions, and a lot of hoping that this Hickory auditing firm has it settled by January. All they can (or will) do is provide a list of trends which lead to difficult times for New River and conclude that the Medicaid issue was the straw that broke the camel's back, and then ask for their check for $60,000. There is no way they will investigate all the somebodies whose behavior and conversations contributed to the destruction of New River Behavioral Healthcare. They will never speak of the personal feud that was at the heart of this disaster. If they did they would lose a lot of county government auditing business. All of us feel sorry for the county boards who have had this thing dumped into their laps but it is theirs to sort out at the risk of litigation. You commissioners have to understand that you are not the object of citizen anger, just their frustration because it looks like we are being taken for a ride by people who really don't care for people, especially the locals who work for them or the clients they serve. This Smoky Mountain outfit is now threatening the 10 member board if they don't grant demands that services will be cut off or they will be taken to court. They just don't get it. This is our ballgame and this is our court and we know how to put people to packing when they behave badly, offend our integrity, and imply that they have the power, they know best and we don't. These guys may be needed somewhere, just not here.

Blogger said...

The writer needs to go back and study the history of this New River disaster. I have written about it beforeso I will keep this brief. Like most of the mental health systems in the country, the North Carolina legislature concluded ours was failing. New River’s system was no exception.

The Assembly ordered a reform of the system which would privatize it. All but two programs, New River being one of them, privatized their systems with companies like Daymark. The New River area county commissioners however, decided to keep the old government-run system.

At the time there was one board member who had the most knowledge as to what was going on everywhere in the mental health field. Trying to encourage our board to do what the rest of country was doing, he warned them that exactly what has happened now, would happen. Now it has and before it is over, it could cost taxpayers a lot of money for a foolish mistake by the county commissioners five years ago.

If at the time, they had hired a company like Daymark as the other systems did, then all that is now happening would have been that private company’s financial responsibility. Our county commissioners were definitely warned they were setting themselves up by keeping ours government controlled.

inquiring mind said...

Well said blogger. What caused the demise of New River? It was doomed to fail before it ever started. The CEO of Daymark came from an area faced with the exact same situation that the 5 counties were faced with. The difference was that he worked along with other to study the alternatives. I heard him tell a reporter that they ruled out the 160-A immediately. He said they finally decided on the private not-for-profit. And, he said they didn't know whether it would work or not; but, it was the best alternative at the time. We need someone of his caliber to take charge of dismantling New River. The one characteristic that I admire the most is the ability to see good in any situation. Like he knows the cars are supposed to come to Daymark. He knew it from the beginning. He was trying to arrange something and then they gave him a raw deal (board claiming he didn't show any interest; later proved false). He never said he needed all of them.

inquiringmind said...

Evidence of impeding SMC from performing LME duties
In reviewing the minutes I came across something that looks like willful collaboration between the New River Service Authority Board and the CEO, Ms. Andrews to conceal information from Smokey Mountain Center while performing their duties as an Local Management Entity (LME). This needs to go to the NC DHHS (DMA specifically).
See the May 27, 2010, Page 11 of 11 of the Minutes: (Direct Quote of Source in italics, bold and quotation marks)
"SMC Issues - Since NR's merger with SMC in July 2007, relationships with SMC have been hard at times. Ms. Andrews stated that since the fall of 2009 the relationship has become more challenging. Zach Henderson stated that in talks he and other county commissioners have had with SME LME Board members, it appears that the SMC CEO has an agenda and it does not appear that NR being their largest provider, is a part of that agenda. Ms. Andrews and Mr. Aggers discussed several issues NR has with SMC (communications, demands, etc.). Just this week Mr. Aggers added, that SMC wants access to NR's medical records system. Mr. Aggers stated that as a LME they do audit records, but limited access is given during the time of audits. Ms. Andrews will not be granting SMC this access. Data that NR is being compared to has been requested of SMC but has yet to be received. The board discussed options the board and counties have. Part of NR's strategy is to minimize NR's exposure to SMC LME. Ms. Andrews asked the board members for their support and to talk with their fellow commissioners and ask for their support of NR."
This is outrageous. And, the New Service Authority Board expects us to take anything an auditor that they hire to expose their wrong-doing and responsibility in this fiasco. If a county finance director withholds information during a financial audit from auditors, then the financial director can be found guilty of a Class 1 Misdemeanor. (Commissioner Miller quipped to me that he was sure he could get our county finance director a "deferment" if that should be the case with her.) Is there a similar law governing audits by the LME? Does Commissioner Miller think that he can get the CEO and CFO and the Board a deferment too?

inquiringmind said...

Among the wage complaints should be the contract between New River and its employees to provide Retiree Health Benefits. Any employee hired before 7/1/2007 is eligible. Any of those employees who have 20+ years of service (service counts pre-7/1/2007 and post 6/30/2007) is vested in this benefit. The policy states: "New River Behavioral HeathCare may at any time discontinue the Retirees Health Care Insurance Benefit 06/30/2007 altogether; provided however, that no such action by the Board shall terminate or reduce benefits which have already vested (20+ service years) with the employee/retiree as of the time the Board takes action."

The Policy goes on to state: "New River Behavioral HealtCare wishes to suport and recognize employees who work long-term for New River Behavioral HealthCare with the continuation, maintenance, and management of the Retirees Health Care Insurance Benefit 06/30/2007 incentive. New River Behavioral HealthCare received from New River Area Board MH/DD/SAS financial support for Retirees Health Care Insurance Benefit 06/30/2007; and may receive any remaining fund balance as of June 30, 2007. The New River Behavioral HealthCare Board will determine, inconsideration of fiscal responsibility, what amount of any fund balance received as of June 30, 2007 will be earmarked for Retirees Health Care Insurance Benefit 06/30/2007."

The "New River Area Board MH/DD/SAS" is the old New Behavioral Health Care that dissolved 6/30/2007 and whose net assets were transferred to the "New River Service Authority d/b/a New River Behavioral HealthCare". As it turns out we don't know how much was contributed to the Retiree Health Care Benefit Plan by the old NRBH; we only know that they gave the new NRBH contributions amounting to over $5 million. We do know; however, that as of 6/30/2007 the old NRBH had a designated fund balance of $438,000 for future employee benefits that was transferred to the new NRBH. However, when the net assets transferred on 7/1/2007 to the new NRBH, it was not transferred as a "designated" fund balance; it was commingled with the "undesignated" fund balance. This is a serious violation. And, now the money is gone. I can't wait to see how the New River Service Authority blames this on Smokey Mountain Center.

At our last count, the liability was $7 million. Add another $2 million now. However, who will be held personally liable for this one. Will it be the 2007, 2008, 2009, 2010 or 2011 board members? Will it be on a first in first out basis and be allocated to the earlier board members or will it be on the last out basis and be the responsibility of the latter members? Or, to be fair, will they all be held responsible?