The Doctor is Out

For the poor, unemployed and mentally ill in St. Johns County, getting the drugs to control chronic depression or bipolar disorder — or even just getting an appointment with a doctor — have been complicated and difficult undertakings. At a time when the number of people in crisis has mushroomed, obtaining community mental healthcare services has grown more difficult.

In July 2011, the St. Johns County Commission shut down its longstanding community mental health clinic amid complaints that it was poorly run and too costly to taxpayers. However, the private company that took over the job on Aug. 1 was no improvement. Patient advocates say clinic clients have been unable to get appointments with Putnam/St. Johns Behavioral Healthcare to obtain drugs critical to maintaining their sanity. Others say patients would show up for scheduled appointments only to discover there was no doctor to see them.

The problems went beyond just poor customer service. According to the state Department of Children and Families, the company’s failure in accountability was so severe, the state had to terminate the contract, effective Jan. 31. DCF announced the move last week, amid concerns about the company’s billing practices, financial stability and ability to provide services. According to the agency’s Northeast Florida communications manager John Harrell, the company owes the state at least $300,000, and that’s just a preliminary figure. “We informed the agency of our concerns over the past few months,” he says, “and the situation didn’t change.”

A complete audit of the company is underway, Harrell says, but the investigation has so far uncovered Medicaid billing discrepancies totaling $87,000, along with more than $200,000 that Putnam/St. Johns must repay the state for services paid for that the company will not be providing. Asked if the Medicaid billing problems might lead to criminal charges, Harrell says DCF will complete its audit of the company’s books. “Ultimately, that is for law enforcement to decide.”

Last week, DCF was negotiating with private healthcare provider Stewart-Marchman-Act in Volusia County to take over the contract on Feb. 1. Harrell says DCF wants the new company to continue providing services at the same locations in St. Augustine and Palatka, and hopes there will be no disruption in care. “We must be responsible to the people who need these services as well as to taxpayers,” Harrell says. “The possibility that these services would be stopped without warning is unacceptable.”

Pattie Hunt, past president of the St. Johns chapter of the National Alliance on Mental Illness, says that Putnam/St. Johns Behavioral Health was overwhelmed by the enormity of the services they’d contracted to provide. She says the company was a small drug and alcohol abuse clinic in Palatka and had no experience providing doctors or drugs to mental health patients or to responding to patients in crisis. “They were overwhelmed from the very beginning,” she says. “When the county pulled out, DCF was required by law to provide the service and they had to scamper around to find somebody to do it, and it just wasn’t enough.”

For some on the front lines of mental health care, the latest provider switch — less than five months after the last one — is troubling. St. Francis House homeless shelter Director Renee Morris says she was shocked to learn DCF had cancelled the contract, and that uninterrupted access to mental health and substance-abuse services are critical to helping clients become self-sufficient. “We really want to be able to make sure our folks are taken care of,” says Morris. “We want to head off someone being in crisis.”

Assistant County Administrator Jerry Cameron, who advocated strongly last year for privatizing county mental health services, is hopeful there is no drop in service. But Cameron, a former chief of police in Fernandina Beach, emphasizes that things must have been seriously wrong at Putnam/St. Johns Healthcare for DCF to feel it had no choice but to pull the plug. “Given that DCF moved as quickly as it did,” he says, “I would suspect this is more than just erroneous billing.”

Since the economic collapse, Morris says, her agency is seeing a big increase in people suffering from chronic depression or turning to alcohol or drugs. “It’s a difficult journey right now,” she says of the upheaval in services. “We are trying to do the best we can with what we’ve got.”

Susan Cooper E

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