Bylaws, Regulations & Breaches: We Pay For This?

By the wording alone of the bylaws of the Fayette County Behavioral Health Administration and its HealthChoices
advisory boards, it would seem unthinkable that the county commissioners and the rest of us would be unaware
for 4 long months that the FCBHA administrator last March approved a contract for county Medicaid recipients
aged 18-55 to receive inpatient psychiatric care at a second hospital in the county.

And even then, last month when we first heard, it's unthinkable that it wasn't the FCBHA director who told us.

No single local issue has drawn more unsolicited opinion from readers here than the Highlands Hospital CEO's
letter written mid-July to the county commissioners and all the drama that unfolded for these weeks afterwards.
In a previous commentary, this editor wondered how long we might have continued in the dark about this issue
had the Highlands CEO not written that letter.

It was clear with
comments from a county commissioner assigned to the behavioral health boards that the
advisory board members themselves met in a special meeting in July because the chair did not feel that they were
made aware of the deal that the FCBHA director had approved last March.

By the wording alone of the bylaws of the FCBHA and its HealthChoices advisory boards, the rest of us should
have known at least 5 months ago.

As per the HealthChoices advisory board bylaws,
"Article 1, Section 3: Duties: to make recommendations
to the county commissioners regarding the program and any other matters relating to the
HealthChoices program and services in the county, including purchase of service contracts and extent of
funds required to implement the program."
This editor notes that each page of the HealthChoices advisory
board bylaws was revised 5/2/12.

As per the FCBHA advisory board bylaws,
"Article 1, Section 2: Purpose: The board shall serve in an
advisory capacity to the county commissioners and to the Fayette County Health Choices CEO to
develop and plan with them those Medicaid behavioral health services mandated per Department of
Public Welfare contract and RFP #11-97."

As per the FCBHA advisory board bylaws, "Article 5, Committees, Section 2 (c): finance and date
committee: This committee shall consist of at least three (3) board members. The committee shall
review and analyze any changes to the Behavioral Health Administration contracts."

By the wording of the bylaws of both advisory boards, it would appear that the county commissioners are
directly linked to these functions, no? Then why did the commissioners not know?

This editor does not fault the boards directly, of course, since it is established that the chairman of the FCBHA
advisory board called a meeting, feeling himself that the boards were in the dark, too, of the
Highlands-Uniontown Hospital Medicaid funding matter. This editor did not receive a Right To Know Law
response that the meeting never happened, in other words, when the request was sent to obtain minutes of that
special gathering. The special July meeting is on record for having happened.

Much mail has come in, as well, from everyone but the FCBHA director, offering opinion about the unanswered
questions this editor has asked the FCBHA director three times -- i.e.,  whether a county mental health clinic
doctor or a provider agency director would be eligible or ineligible, due to a conflict of interest, to serve on the
FCBHA or Health Choices advisory boards. If allowed, then there's no conflict with the Uniontown Hospital
doctor and director of nursing to be seated in those advisory board seats. So why won't she answer?

Many working in the field confirm this editor's original thought. We don't know of any clinic doctor or provider
agency director to serve on the advisory boards. Perhaps none were ever interested? Perhaps we're too old to
recall if one or more were seated on those boards. This editor clearly recalls, however, 2 clinic doctors in
previous years stating they were not allowed to sit on the county administration advisory board.

Given that one clearly believed that mentally retarded people should never have left state centers for group homes
in our neighborhoods and that the other entered the clinic waiting room to put his hands on the shoulders of
patients to cure them of their mental illness, it was unclear to this editor back then if they were ineligible to sit on
the county mental health advisory board because they, well, were not the type of person for the role or simply
because they worked for a provider. They both then indicated they were ineligible because of a conflict of

That none of us recalls a clinic doctor or a provider administrator sitting on the county mental health advisory
board does not mean this has never happened. But all of us together should have been able at least to rattle off
one name.
Question 8 of the application for persons wanting to sit on the advisory boards asks, "Have you been
employed, or are you currently employed at any county office or provider of service agencies?"  Do we expect
to see a rush of applicants coming in to be provider agency staff  to test whether they can serve on the county
advisory boards? Hardly. The county office controls their funding, remember. But the question we asked deserve
a clear answer.

Highlands Hospital staff, rightfully so, feel betrayed. They learned through the grapevine instead of from the
FCBHA director directly that a second inpatient unit to serve Medicaid recipients aged 18-55 was open in the
county. They learned through this column that they are paid less than Uniontown Hospital is paid for the same
service. And their staff maintain that Highlands provides over $1 Million dollars of free psychiatric care per year
to the uninsured and persons who do not qualify for county Medicaid behavioral health care through FCBHA.

None of this started in the three weeks since mid-July, when the FCBHA director was off work. It started at
least five months ago, when the FCBHA director approved Medicaid funding for behavioral health services and
neglected to tell anyone else. It's also correct to say it stated three years ago, when Uniontown Hospital received
its license to operate its geriatric psychiatric services.

The FCBHA director's failure to inform the commissioners, Highlands Hospital staff and the rest of us was a
breach of state program regulations or codes, as well as breaches of the bylaws of her own advisory boards.

Why is that the county commissioners allow the FCBHA director to get away with this is an often asked question
received here. Respectfully, this editor refers those asking to pose that question to the 3 county commissioners.
This editor has only speculation, whereas, commissioners need to provide an answer.

11 Aug 12
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