Two Boards met this week to determine the future of CenterPoint Human Services and its CEO Betty Taylor. The Forsyth Board of Commissioners met and voted on accelerating payment of the County’s annual appropriation to CPHS, funding a loan to CPHS, how the Board members at CPHS would be approved, and in a bully move on both CenterPoint and Davie, Stokes and Rockingham counties – whether or not to explore other entities to manage FC’s delivery of disability services. CPHS’ Board of Directors met the following day, in a meeting which included a closed session to take what must be assumed to be a vote of confidence on Betty Taylor.
Monday night, in their regularly scheduled Board meeting, Forsyth County Commissioners addressed four items related to CPHS. Advocates for people with disabilities made use of the public comment period to express their concerns and desires just as they have in several of the last meetings of the Commissioners.
This meeting, however, the speeches got personal. Self-described Mental Health advocates changed their message to the Board from previous meetings, where they had asked that the loan be denied, to request that the loan to CenterPoint be granted so that their services would not be cut. They maintained their displeasure with CEO Betty Taylor, citing personal experiences where they had been disappointed, embarrassed or called out on their behavior in meetings as reasons that Taylor should be removed. One speaker, after going over her allotted time, directly addressed Commissioner Everette Witherspoon, accusing him of not attending enough of the CPHS Board meetings and then stating that she knew more than he did about the issues with CPHS and the realities of the new Waiver implementation. As Witherspoon began to address her accusations, she turned and walked back to her seat, mumbling to herself as he spoke. Witherspoon continued to defend himself against her attack by declaring that he owns a company going through Waiver, so regardless of how many CPHS meetings he has attended on the subject, he still knew more than she did.
All of the advocates who spoke requested the funding be approved, but a division among advocates became apparent on the issues of CenterPoint’s leadership and the future of Forsyth County’s relationship with the entity. One speaker expressed frustration that other advocates were attempting to demonize CPHS, and declared her experience to be so different that it seemed people were talking about two different CenterPoints.
After addressing numerous other budget and zoning items, the Board came to the issues regarding CenterPoint. The members voted 5-2 to approve accelerating the payment of the annual appropriation to CenterPoint, with Commissioners Whiteheart and Whisenhunt voting against.
County Manager Dudley Watts presented a revised resolution on the reimbursable grant (loan) to CPHS to be used to restore service programs. The resolution required that CenterPoint budget the amount of payback due the County from the schedule of debt that would be agreed upon. It also gave the County the ability to take the money out of their normal annual appropriations to pay themselves back “should that become necessary”. Because the County is, in an unprecedented method, requiring a loan agreement be drawn up instead of granting funding, CenterPoint will have to take the legal document adopted by the entity and the County to the Local Government Commission for approval. The LGC meets the first Tuesday of each month, and requires that items be presented 30 days ahead, so the earliest that CPHS’ loan approval could be granted would be November 6th, leaving CPHS without funding for services for at least 4 months. Chairman Linville said the reality that CenterPoint has already had to reduce two months of patient services along with the fact that the loan “has no impact” on the County’s budget motivated him to finally decide to support the idea of the loan if they “put further safeguards in there to protect the County’s interest.”
Those safeguards include a provision that even if the terms of the “loan” are approved by the LGC, CenterPoint would have to provide services to their clients and then submit billings to the County’s finance department before they money would be payable. The end result of that process is that CPHS has to go through all of the steps to receive a loan from the County, but will not have discretionary access to those monies, only the potential for reimbursement by them. The loan becomes more of an overdraft protection than an actual line of credit.
After discussion, the “loan” item went to a vote and passed 4-3, with Commissioners Conrad, Whiteheart and Whisenhunt voting against.
The third item related to CPHS was a resolution recommending that the method of appointing members to the CPHS’ Board of Directors be changed to require a vote of the full Board of Forsyth County Commissioners. Commissioner Conrad pushed to have the entire composition of the CPHS Board restructured to give Forsyth County the majority vote over even a combination of Davie, Stokes and Rockingham’s members, but the County Attorney advised that the statue being used to adjust how Forsyth appointed their members did not allow for one County to determine the allocation of seats on the Board, but instead requires that “Counties must come together to determine adequate representation”. Commissioners Witherspoon and Marshall expressed concern that adopting the full Board approval method would result in partisan appointments rather than qualified appointments in the same way that Commissioners have determined Board of Health members or the way the W-S/FC School Board determined a recent appointment. The resolution did pass 5-2 upon vote, with Witherspoon and Marshall opposing in a break straight down party lines.
The final item addressed relating to CPHS was the one that had raised the most discussion amongst advocates and has the greatest potential impact on not only Forsyth County’s services for people with disabilities, but the other three counties for whom CenterPoint manages services. The resolution requests and authorizes County Manager Dudley Watts to “Explore other Local Management Entity options for governance and operation of Forsyth County’s Mental Health, Developmental Disabilities and Substance Abuse Programs.”
This resolution was offered by Chairman Linville in an effort to appease those Board members and advocates who have a personal issue with CEO Betty Taylor’s management of CPHS. The law states that after their initial choice of a Managed Care Organization to manage their County’s Waiver program, no County can change their MCO until July 2014. That, combined with the law’s provision that all Counties must have adequate representation on the Board means that FC cannot legally remove Betty Taylor from CPHS’s management. The only option for those frustrated with Taylor is to go with another MCO. The resolution is a bully move not only on Betty Taylor, but on the other Counties who make up CPHS population. Forsyth County makes up the bulk of the 500,000 person “catchment area” that is required to operate a MCO under the new law. Moving Forsyth’s participation from CPHS would ensure that Davie, Stokes and Rockingham Counties would have to work with CPHS to find other counties willing to join with them to make up the catchment requirement. If they were not able to find enough people to join, CenterPoint would go out of business, and those counties would have to join other MCOs in the State.
Commissioner Witherspoon reminded those present that his whole career has been related to Mental Health, and stated that his reason for getting involved in the profession was because of his personal exposure to his Grandmother who had a nervous breakdown and did not participate in society for 30 years afterword. He then expressed his frustration with Mental Health Advocates apparent witch hunt on Betty Taylor. “I have no problem with the Mental Health Coalition, but a lot of people consider you arrogant. When you asked me to go against Betty Taylor and CenterPoint and provide a Board member of your choosing, I did it.” Witherspoon said. “But the first time I disagree with you, you attack me.”
After reminding the Board and advocates that other MCOs have requested millions of dollars from their participating counties, are involved in multiple lawsuits and/or have failed to make the transition to Waiver or gain clearance as a Waiver site, Witherspoon said “I think Betty Taylor and CenterPoint has done a great job. Perfect job – No. But no other agency has done a perfect job.” He continued “I can’t support this agenda item because I believe the best thing to do is have a Managed Care Organization right here in Forsyth County – it’s best for the clients, it’s best for the people.”
Commissioner Marshall also stated his disapproval of the item, saying “I don’t think, given what is out there , that we’re gonna find an option that is better.” He agreed that Betty Taylor and her team could improve communication, but stated that “to single her out, knowing what goes on county-wide, is unfair.”
All of the other Commissioners were in favor of exploring other MCOs. Commissioner Whiteheart, in his typically blustery manner, informed Witherspoon and Marshall that they were confused about what the resolution meant. He stated that “the verb in item 19 is ‘explore’” and that he believes “it is the duty and obligation of this board… to always explore opportunities, to implement best practices and best solutions for anything that affects the citizenry of our County.” Attempts by CCD to determine whether or not the Board explored other MCOs before joining with CenterPoint initially have found no results.
In an explanation as to why Whiteheart felt it necessary to explore other MCOs to provide oversight for Forsyth County’s Mental Health, Developmental Disability and Substance Abuse services, Whiteheart pontificated “This particular issue, of Mental Health, in my opinion – and I believe in the opinion of the vast majority of people within the sound of my voice – and public opinion, has been mismanaged by the Federal government, been mismanaged by the State government, and I don’t intend to help mismanage it at the Local government level.” He continued, “I intend, with these others, to dedicate ourselves to looking for a better way to solve the problem.”
Commissioner Witherspoon responded to Whiteheart saying “I don’t think we should explore how to give jobs away to another County. I mean, that’s just ridiculous.”
The Commissioners then voted to pass the resolution 5-2, with Witherspoon and Marshall opposing.
After the item passed, Marshall addressed Manager Watts, asking what exactly the resolution would mean in practicality going forward to the July 2014 date when a change would be allowed. Watts stated that the process would include “a workgroup that is very open” seeking input from the disability community and other individuals who could offer understanding of the very complicated issue. That would include inviting input from a wide group from the community, monthly meetings and open communication. He said that he would look at what the other options are and gather information for the Board to consider.
In a move that seemed to catch Board members off guard, indicating that they thought the vote would have effectively dissolved CenterPoint, Watts stated that he believed that his research and communication with individuals with knowledge of these issues across the state indicated that in the future there will be “a round of mergers” among MCOs. He went on to state that he thinks “there will be fewer MCOs 2 years from now than there are even right now.” In a statement that either confirms the Mental Health community’s influence on the Board or demonstrates a lack of understanding about the breadth of services offered by the MCOs, he stated that the issue at hand is really “how do we merge effectively, not to move to some other community, but how do we, if we’re gonna build Mental Health – Mental Health services in this community – how do we do that so that people are merging with us.”
Commissioner Whisenhunt wanted to have the last word on the issue. “I hope that all the members of, on Centerpoint [Board] have taken in everything that’s gone on for the last few weeks. “ Whisenhunt stated. “Um… we have had problems here for years and years. We had people coming to us and ask for help for years and years. Recognizing that the Commissioners do not have that much authority, but I do hope that the CenterPoint board tomorrow night when they are in closed session will take… take some sort of action. I have heard so many people say ‘This is not about Betty Taylor’. Folks… this is about Betty Taylor.”
The next day, following the decisions of the County Commissioners, the Board of Directors of CenterPoint Human Services met at noon in a specially called meeting. The full Board was in attendance, and representatives from all four participating counties were able to hear the updates from the loan request as well as learn of the new developments that have potential impact on their county’s future services. In spite of the fact that the meeting was open, no members of the public attended. (including those who had been at the County Commissioners meeting claiming that Centerpoint would not let them attend meetings.) Those present were given a packet of budgetary statistics, graphs and charts of actual and projected expenses, the By-laws of the CPHS Board of Directors, copies of the Session Law related to Waiver and the respected Boards involved, and a list of those providers who are directly impacted by the need to use Forsyth County’s discretionary funding to implement Waiver.
After the updates, the Board of Directors entered into a closed session. The agenda for the meeting stated the purpose of the closed session was to “consider the qualifications, competence, performance, character, fitness…of an individual public officer or employee… or to hear or investigate a complaint, charge or grievance by or against an individual public officer or employee.” The Board met in closed session for approximately 20 minutes before reopening the public session of the meeting.
After the meeting adjourned, CCD asked Melanie Barbee, Chairman of CPHS’s Board of Directors, if she had any comment on the results of the closed session. Barbee said that she was prohibited from discussing the events of the closed session, but stated that “This Board is continuing to be supportive of Betty Taylor. We’ve got work to do, and we’re moving forward to do it.”
LME Projected 2013 Map
Proposed Local Management Entity – Managed Care Organizations (LME-MCOs) and their Member Counties on January 1, 2013