Crisis Triage Center?

Some respected local behavioral health experts fear the County will make a huge mistake Tuesday by going forward with Recovery International to run the long-vacant Crisis Triage Center; but the County officials who’ve worked on this longest and hardest say RI is the right choice ─ “and we’re lucky to have them.”

Smart people who want the County to choose its best path have very different roadmaps.

Certainly the optics are problematic. Instead of publishing an RFP, the County (using a statutory exception) paid RI $50,000 for a plan, based on which the parties would now negotiate a contract if the Commission approves. 

 

In 2013, Governor Martinez savaged mental-health providers here, using false or hugely exaggerated allegations, and replaced them with an Arizona outfit with which her people had been talking even before suspending the local agencies. The Arizona outfit found disappointing profits and quickly fled. We’re still recovering from the damage.

The face of RI (another Arizona company) is Dr. Wayne Lindstrom, who was involved in that earlier saga. Martinez hired him after suspending those companies, but to some folks his presence alone might almost be a deal-breaker. County officials say Lindstrom was just helping to pick up the pieces; but others complain his conduct then was unhelpful. 

 

County officials say RI, which runs 12 other crisis centers, wrote the book. RI was one of several co-writers of the well-regarded SAMHSA Guidelines. Critics say half the “business plan” we paid RI $50K to write was cribbed from the Guidelines, to which access is free. County HHS Director Jamie Michaels says beyond the portion tracking the Guidelines, the plan contains more than $50,000 worth of good ideas and knowledge.

Commissioner Shannon Reynolds and others ask why we paid $50,000 for a “plan” when the RFP Process might have yielded more than one set of good ideas – free. Michaels and County Manager Fernando Macias say they initially lacked the detailed knowledge to write an RFP and sought RI’s expertise, then were so impressed, and developed such a good relationship with RI, that they opted to recommend moving forward with RI. 

 

People say RI relies too heavily on peers with “lived experience”; that RI would have a psychologist or psychiatrist on duty just 15% of the time, mostly by telemedicine; and that obtaining necessary licenses and certifications in New Mexico could take a year or two – and that we’d pay for it. Michaels says that RI’s experience and the State’s desire to get the center open would shorten that process to a few months, and that hiring a local person certified in peer crisis counseling would eliminate part of the potential delay. Maybe.

 

There are many more issues, including how RI would mesh with the local mental health community, and that the Triage Center is just one of four “core elements” of an effective behavioral health crisis system. The LC3 Behavioral Health Collaborative – with representatives from 60 entities here – wrote the County a long memo suggesting that providing “comprehensive and continuous care” embedded in strong knowledge of the community is essential. The message was: Slow down! Coordinate. 

 

Two capable county commissioners appear strongly against negotiating this sole-source contract with RI. Some capable staff strongly favor it. 

 

I’m not sure the Commission has adequately considered community concerns, which are sometimes expressed delicately because the County funds local agencies. For the sake of our community health and well-being, let’s get this right.

                                                      – 30 --

[The above column appeared this morning, Sunday, 12 July 2020, in the Las Cruces Sun-News, as well as on the newspaper's website the newspaper/s website and on KRWG's website.  A spoken version will air during the week on both KRWG and KTAL, 101.5 FM (Las Cruces Community Radio), and will be available on demand on KRWG's website.]

[I'm tempted to say that the only thing everyone agrees on is that that the Crisis Triage Center should be named after Ron Gurley, whose idea it was and who worked so hard to make it happen. ]  

[inserted Monday evening, 13 July:]

In writing the above column and blog, I assumed, without researching it, that the statutory “Hospital and Health Care Exemption” applied to permit the county’s proposed departure from the normal requirement to publish a Request for Proposals. However, once a County Commissioner suggested I read the statute, that reading raised new questions. I’m not a municipal law specialist, and the press of other business today precluded my researching the law as completely as I’d have liked to. However, below I’ve reprinted the law and raised some questions I hope county management will address before or during tomorrow’s meeting.

13-1-98.1. Hospital and health care exemption.

The provisions of the Procurement Code shall not apply to procurement of items of tangible personal property or services by a state agency or a local public body through:

A.  an agreement with any other state agency, local public body or external procurement unit or any other person, corporation, organization or association that provides that the parties to the agreement shall join together for the purpose of making some or all purchases necessary for the operation of public hospitals or public and private hospitals, if the state purchasing agent or a central purchasing office makes a determination that the arrangement will or is likely to reduce health care costs; or

B.  an agreement with any other state agency, local public body or external procurement unit or any other person, corporation, organization or association for the purpose of creating a network of health care providers or jointly operating a common health care service, if the state purchasing agent or a central purchasing office makes a determination that the arrangement will or is likely to reduce health care costs, improve quality of care or improve access to care.

History: Laws 1998, ch. 69, § 1.

I have not heard the County specify whether it contends that subsection A or Subsection B authorizes its proposed conduct here. However, as (A) applies solely to an agreement to “join together for the operation of hospitals,” and the Crisis Triage Center would not seem to be a hospital, (B) seems the more likely. (Each subsection requires that either “the state purchasing agent or a central purchasing office makes a determination that the arrangement will or is likely to reduce health care costs, improve quality of care, or improve access to care. Has the county’s purchasing department made such a determination? Did the determination provide a factual basis for a conclusion that proceeding without an RFP was superior in one of the ways set forth in the law?)

Subsection (B) could apply if this is “an agreement . . . for the purpose of . . . jointly operating a common health care service.” Let’s assume the Triage Center constitutes a “common health care service.” Does the County contend that its proposed engagement of RI to run the Crisis Triage Center is a proposal to run the Center jointly? Certainly it has sounded more as if Doña Ana County would pay RI to run the Center.  And Resolution 2013-90 states that "the Commission has determined that it is time to move forward with the process of selecting a provider to run the center" and authorizes the County Manager to start that process. 

These are questions. I do not presume to offer answers. However, underlying the discussion that Legislature’s language suggests doubts be resolved in favor of maximum fairness, not maximum administrative convenience:

13-1-29. Rules of construction; purposes.

A.  The Procurement Code shall be liberally construed and applied to promote its purposes and policies.

. . .

C.  The purposes of the Procurement Code are to provide for the fair and equitable treatment of all persons involved in public procurement, to maximize the purchasing value of public funds and to provide safeguards for maintaining a procurement system of quality and integrity.

In short, I hope the county manager or the county attorney will articulate with specificity the legal basis for concluding that the exemption applies. I think doing so, rather than leaving the matter uncertain, minimizes the chance of wasteful misunderstandings and perhaps unnecessary litigation.