Tag Archives: privatization

New York State Lags on Firing Workers Who Abuse Disabled Patients


In this NY Times article, Mr. Hakim seems to have understood that there is no point in arguing against the mental health system, or OMH/OPWDD. He threw the proverbial towel on them and is now focusing on the unions. The state came with a new law (Justice Center) that is more of the same loopholes to protect everybody but leave us VOICELESS. It’s a SCAM is what it is. The unions are the tip of the iceberg of the culture of abuse in the NYS mental health system.

Let’s be fair: the mentally ill is food for the big and small sharks equally.

Look, in ALL of the mental health system’s rules, old and new, the MANAGEMENT and PROVIDERS are off the hook from responsibility for abuses on the recipients of services. Abuses happen in their watch. Some of them are directly responsible for abuses, and most of them ENABLE the abuses. It’s what I call ‘the culture of abuse in the mental health system’.

Under those conditions, I too would want the union to stand for me if the supervisor, who knows what I do and laughs at it, is going Scot free.

The Justice Center was intended to stop the NY Times ‘complains’ AND to avoid the federal government from doing an investigation on the state’s practices. That explains why the Justice Center is WORSE than what we had before: now people THINK that SOMETHING was done with the issue of abuse when in actuality it’s worse.

Nothing was done. It just made it MORE DIFFICULT for us to report, and it provides MORE protection to the ‘providers’ and workers. There is LESS transparency.  See my comments to the Justice Center law in this blog.

OMH privatization of the mental health system, Cuomo’s surrendering the functions of government to the private sector, THAT’s where the problem is, politically speaking.

A policy system per logic has to put the responsibilities of failure of the policy on those who write and enact them. In this case, the NYS OMH/OPWDD system. Privatizing, reducing the mental health workforce and reducing their salary and benefits is a recipe for disaster. You can’t write ‘moral codes’ (as Justice Center pretends will do)  for those workers you hire  because, them been the lowest of the lowest, you know they are the cheapest.

I think Mr. Hakim should take a closer look at how the system protects the providers and managers. They are the one who must respond for their ENABLING abuses.

 

About Privatization, fracking and Lucy the psychiatrist. 5


This post will close the ‘series’ on privatization of the NYS public health and mental health system. It’s difficult to make these posts short; the topics are too big. I will try to be economical. So, please, don’t give up on reading. 🙂

The roadmap leading to privatization

You can’t claim that the NYS government is not ‘transparent’. I have discovered since I started this blog that almost every piece of government policy that takes our collective property and rights have been announced beforehand to the public, like Garcìa Màrquez’ “Chronicle of a Death Foretold”. This applies to the latest big report: governor Cuomo’ SAGE Report published last month, February, a roadmap showing the steps  to PRIVATIZE the STATE: public land, public transportation, agencies transformed to ‘efficiently’ serve Wall Street, mental health programs run, literally, by Wall Street.  How many of you have heard about it or have bother to read it?

These ‘steps’ are hidden behind fancy names like “government efficiency“, “right-sizing” (to hide down-sizing), “initiatives” like the “centers of excellence” and “collaborative approach with private and public sector“, “pay for success”…They all relate to privatization, transferring our infrastructure and government functions to you know whom. Worried about fracking? Don’t;  Cuomo will put the responsibility of protecting our environment on the polluters themselves.

Let’s see some of those steps towards privatization, and don’t forget: the recommendations given are usually adopted, at least in part if not in totality. Also, the heads of all these commissions are your typical Wall Street friends. These are the reports mentioned here:

The Commission on Health Care in the 21st Century

OMH/DOMH licensing scheme

Workforce Report

The MRT report

The SAGE report

Step #1: “The Commission on Health Care in the 21st Century”: privatization ‘by all means possible’ and fast, please.

This one is appalling. It (over 200 pages) was commissioned by our legislature and governor in April 2005 to, basically, privatize hospitals and facilitate mergers and cut the competition. The title is misleading, a slap in the face of New Yorkers: You can’t change a health care system in ONE year, which was the length of this ‘plan’; plus, it was all about merging hospitals.

These recommendations were then to be transmitted to the Governor and the Legislature on or prior to December 1, 2006. The binding recommendations were to go into effect on January 1, 2007,” and not later than June 30, 2008.  (All quotes are from the DOH’s report on the Implementation of the Report of the Commission.)

They were in a rush to do this, wonder why?

At the head of the Commission was, guess who, someone with huge ties to Wall Street’s companies gambling on hospitals and health care:

Stephen Berger is Chairman of Odyssey Investment Partners, a private New York investment firm that specializes in private corporate transactions.” [ There’s more to that guy than that.]

This commission’s recommendations accelerated and facilitated a hospitals-merging feeding-frenzy that had started in 2003 and which continues even today after the ‘recommendations’ expired. The cost of this “reconfiguration of the health-care system” (assault on New Yorkers), of closing and paying the debts of the private entities closed, of facilitating mergers, of transferring state property to private hands, of filing for bankruptcies to save themselves, cost tax payers (as they reported, which is always an underestimation) over ONE BILLION dollars in one year.

dr-evil

Included was the cost of defending this atrocity in court:

“numerous lawsuits [more than 20] were filed seeking to prevent implementation” and “the State Attorney General’s office, …created a special group of attorneys to defend the cases…” “The Department substantially prevailed in litigation challenging the constitutionality of the legislation establishing the Commission.”

The recommendations included

“recommendations that municipal and state-operated facilities join together with not-for-profit corporations, in which the plaintiffs argued that such arrangements would be illegal. As described later in this report, however, the Department determined that the facilities could legally join together in a contract merger, in which the efficiencies contemplated by the report were realized, while the legal barriers were avoided.”

The funny thing is that our media didn’t report this hospitals-merger feeding-frenzy was actually designed by the state. On the contrary, the same wolves implementing this assault on us, the state and the Department of Health (DOH), cried innocence. These are all fascinating articles about this:  New York Hospitals Look to Combine, Forming a Giant;  Goal of the NYU-Continuum Hospital Mega-Merger: Raising Prices; this one just announced in March 2013: Mt. Sinai & Continuum announce merger plans, and this one is excellent: As Hospitals Face Pressure, Six in Brooklyn Could Close.

One of the appalling things about this report is that it showed that the state behaved as a Mafioso in order to do the damage quickly:

“Forced hospital mergers [were implemented]”,

“The Department Engaged in Unilateral Enforcement Efforts as Appropriate”

“…it could not easily require a facility to provide unwanted services, or to provide services in a configuration that was not financially or clinically feasible.”

“Nevertheless, the Department at all times insisted on…compliance”

“effectively foreclose the pursuit of constitutional claims, at least in State court.”

“preserve and protect the public health and safety only when the Department determined a safety issue could exist or when updated data made a clear and convincing case that a safety issue existed, [you had to REALLY make your case]”

“the Department [of Health] did not re-evaluate the Commission’s conclusions, or attempt to replace the Commission’s judgment with its own.” [it complied with the Wall Street guy’s recommendations as ordered].

I have to say that the ONE thing that threw me off my seat was the recommendation that OMH’s unlicensed facilities be made licensed again. The cause of the Citywide Mental Health Project was validated years ago. I knew we are right on our claims! Of course, that was the ONE recommendation ignored.

Step #2: OMH/DOMH licensing scheme

OMH was created in 1977 (per President Carter’s Commission on mental health) right after the 1972 Willowbrook case. Since THEN they have been acting like a corrosive acid on our system. Not only did OMH engaged and sanctioned (up to 2010) the same crimes that led to its own creation, human medical experimentation (previous posts), but they turned the back at the mandates given to them, as I described in my previous posts. OMH has been decertifying programs since the early 1990s; at least that’s what I have found.

By de-certifying most of our mental health system, these two agencies have de-facto privatized it without the people’s knowledge. You can’t reverse that without a major public movement, which requires the awareness they don’t have about what these agencies are doing. Most people are unaware that the programs they use are unlicensed. The people trust these agencies blindly because, otherwise, they would have to perennially keep an eye on them.

OMH has ‘rules’ to attract businesses by paying between 50 and 100% of the loans they take to run their businesses (PART 521. FINANCIAL ASSISTANCE FOR CAPITAL ACQUISITION AND CONSTRUCTION). This is done under the excuse of creating the facilities where services will supposedly be provided. But, despite all that public money, OMH refuses to license most of these businesses and, instead, gives them the ‘freedom’ to act unaccountable to anybody. This is how I understood that rule. I hope to be corrected by someone up there if I’m wrong.

Step #3: On the Workforce Report and Lucy the psychiatrist

This one is la creme de la creme. Not only OMH argued there  that we don’t need a licensed system, it said that we don’t need licensed professionals. It seems to insinuate that a case manager acting as a psychologist is as ‘safe’ and ‘efficient’ as a licensed psychologist. I’m not kidding. This is the background:

State’s legislators required in 2010 that a workforce study be conducted to determine what would be required for mental health agencies and non-for-profits to come into compliance with licensing by 2013. The issue is whether the state should enforce the requirement that these entities hire licensed professionals (which some legislators want to do) or that, on the other hand, they be granted a ‘waiver’ to allow them to hire unlicensed professionals to provide the same services as licensed do. It all has to do with the ‘corporate practice doctrine’, which I will not discuss here, but you can read a good history of the corporate practice doctrine here. It’s a fascinating controversy about corporations running health services businesses when they are not physicians.

The point is that OMH made the following conclusions in its report, basically saying that we don’t need the protections that come with a licensed system because, well, they have such a great history of protecting us and a great structure to provide the oversight they know is indispensable anywhere you hire people to do things. Take a look at how to downgrade quality of services:

They said that despite the fact that

“…15% of case managers were performing psychotherapy

and that

“…more than half of the agencies [“licensed”, imagine the case for the unlicensed] responded they employed titles that can be “licensed or certified” however were reportedly filled with unlicensed staff… including psychologists and social workers positions.”

…they concluded that:

lucy“OMH does not find a material difference in the quality of services provided in programs which also employ unlicensed staff.” [Meaning, perhaps, that the 15% case managers mentioned before with two or four years of college are as good psychotherapists as a real one who must have a doctorate degree to practice.]…

and that

[licensure]…would not provide any meaningful measure of increased safety or quality to our citizens as reflected by the survey results.”

We are also unaware of any evidence that would support better client outcomes with increased licensed staff, given the multiple layers of protections that exist in OMH licensed and funded programs.”

So much for the ‘best practices’ philosophy. OMH concluded that more unlicensed programs and unlicensed staff [performing as licensed] are better because they save money and, well, who needs a psychologist or social worker when a case manager can do ‘the same work’ for less? For those reasons, OMH concluded that the State ought to make permanent the exemption of requiring licensure for the professions and services discussed:

“OMH recommends to make permanent the exceptions…”

Credit to the DOMH: they argued in favor of licensing in their own report; goes to show that the ‘system’ is not monolithic.

Step #4: The MRT report

Many of you are familiar with this 2011 Medicaid Redesign Team. Same crap. Cheapening the system, facilitating involuntary commitment by allowing RN to do it without psychiatric authorization, re-working the work force (changing titles responsibilities in mental health services to push them down to less skilled workers), putting programs in private Wall Street corporations hands…Head is Wall Street guy.

Step #5: The SAGE report or ‘wake up! you are being robbed blind’

I don’t even know how to start with this one. It is difficult to unmask this initiative because of its exquisite double-speak language. Take for example the “pay for success program”. Sounds good, inoffensive:

“…the performance based approach known as “Pay for Success” contracts. These contracts, also known as “social impact bonds,” are an innovative financing mechanism that uses private and philanthropic funding sources. Provided at no risk to taxpayers, funding from these external sources is used to fund initiatives and improve programmatic outcomes in key areas such as human services, public safety, juvenile justice, public health, and others.”

Hmmm. Let’s see: “no risk to tax payers”, as if in this corporationist system the “private funding sources” are willing to bear the ‘risk’ instead of the government. This ‘pay for success’ initiative should be called ‘the government pays either way: for success and for failure’. Nothing new there.

Billionaire mayor Bloomberg is credited with opening the door to this shark attack from Wall St called “pay for success”: Goldman to Invest in City Jail Program, Profiting if Recidivism Falls Sharply

In New York City, Mayor Michael R. Bloomberg plans to announce on Thursday that Goldman Sachs will provide a $9.6 million loan to pay for a new four-year program intended to reduce the rate at which adolescent men incarcerated at Rikers Island reoffend after their release.

Right from the outset the shark shows its teeth: IT’S A WALL STREET LOAN, people! Somebody has to pay it. Hello! Anybody there!? 🙂

How sweet is that? Goldman gives HIMSELF a loan to gamble on your kids’ minds, loan which YOU will have to pay, and Bloomberg expects ME to believe this in the caption about this “pay for success” deal:

wall

“If the program reduces recidivism by 10 percent, Goldman would be repaid the full $9.6 million; if recidivism drops more, Goldman could make as much as $2.1 million in profit; if recidivism does not drop by at least 10 percent, Goldman would lose as much as $2.4 million.”

I’ll let you to figure that one out. I’m laughing so hard I can’t deal with it. Pay for Goldman’s success!! BUT WAIT!! It gets BETTER for Goldman.

Why put his own money, after all? This is what the SAGE report has in mind. It’s already working.

“The Governor’s 2013-14 Executive Budget advances this innovative, performance-based public-private sector partnership by authorizing up to $100 million in Pay for Success initiatives over the next five years.”

Did you catch that?

Look, among the other goodies for corporations are:-

– letting them license themselves – no need for the government to do it, plus it gives jobs to lawyers:

“Through this program, applicants have an attorney certify the accuracy of their application [for license], which allows SLA to expedite the review process”

– worried about fracking? No need no more:

“Reform of the State Environmental Quality Review (SEQRA) Process.This permitting process includes reviews by multiple agencies and support from environmental consultants, is extremely technical and can cause delay in some instances. As part of its efforts to reform SEQRA, DEC solicited feedback from stakeholders with diverse interests to identify how the process could be streamlined and delays avoided, without sacrificing meaningful environmental review and protection.

– workers, be worried. Civil Servants system is protected by our state’s constitution. Not for too long anymore.

“The Commission has identified as an option for future consideration certain changes [hmm] in the law governing the State’s civil service system that would facilitate workforce modernization.” 

“workforce modernization” as in going-back-to-the-middle-ages. That’s double speak.

“Controlling Wage Increases. In addition to controlling the cost of the State workforce by exercising discipline in new hiring, Governor Cuomo arrested the growth in per capita employee spending by entering into new four and five-year collective bargaining agreements that included no salary increases for the first three years of the agreements[now, THAT’s modernization.]

LIPA will be privatized together with other ‘assessts’, meaning transportation and public buildings.

There are a few good things there, but the bad things are the one they are not telling you about. It’s all in the works. We are ‘screwed’, excused my English. They will use the language that makes you say ‘hmm, that sounds good’ and you will consent to this attack.

Well, that’s my long speech about privatization. I hope this made sense. Please, feel free to post your comments.

By Lourdes

Re: NYS Law 7400 creating the Justice Center for the Protection of People with Special Needs#6


(f) where applicable, establishing uniform procedures for character and competence reviews of provider agencies initially, and upon renewal of licenses and operating certificates requiring a review of performance records regarding incident management, the role of the board of directors in maintaining oversight over agency performance in this area, and the management of incidents affecting resident safety, including cases of systemic problems.

Ay ay ay! Again??

Many many years ago OMH had a system where they would post in their website info about how many complains against providers have been received and how close they were to lose their licenses. That was when the ‘not licensed’ was not so widespread. Then they stopped this practice because…well, you guess why.

For many many years afterwards, complains were not recorded, period. Now we are back at doing what they really don’t want nor intend to do.

In the first instance, complains from consumers in ‘not licensed’ programs will automatically be left out. Mind you, more than half of all programs are ‘not licensed’. I claim that our ‘public mental health system’ does not exist. If more than half of the programs are not licensed, meaning private, how can we claim to have a ‘public mental health system’?

There are better ways to keep track of complains including letting consumers figure out how to keep track of their complains in the programs.

In the second instance, how do you determine ‘character’ when those affected by that character can’t inform you whether they have been treated with dignity or not?

Have you noticed that this new bill has no provisions for meaningful consumer input?

Re: NYS Law 7400 creating the Justice Center for the Protection of People with Special Needs#5


29 3. (a) when any allegation that could reasonably constitute abuse or 30 neglect is received by the register, the register shall accept and immediately transmit notice of the report orally or electronically to the appropriate state oversight agency and, as appropriate, to the director or operator of that facility or provider agency. (i) upon acceptance of a report of abuse or neglect by the vulnerable persons’ central register, promptly commence an appropriate investigation;

I know it looks as if I were against everything, but that is not the case. It’s difficult for people who have been entangled in the bureaucratic web while trying to resolve problems with it to not recognize the problems that these ‘new solutions’ create. Case in point, the above quote from the BILL 7400.

This new bill eliminated the Commission on Quality of Care because the commission was doing nothing. The commission would receive complains and dismiss them as ‘not reasonably constituting abuse’. By their own account in 2011, out of a bit less than 10k complains, they “screened” only 250. That means that they found the other 9k plus complains to be ‘not reasonably constituting” abuse. Yet, the commission was eliminated because there was abuse and they did nothing meaningful, they even didn’t include the cases denounced by the NY Times because those cases were in ‘not licensed’ programs and not licensed programs were not part of the commission’ surveys.

So now a clerk is going to receive some complains over the phone and make a decision right then and there that the complain “reasonably constitute abuse”. Then “(i) upon acceptance of a report of abuse or neglect by the vulnerable persons’ central register, promptly commence an appropriate investigation;”. That means that if they don’t accept the report, nothing will happen.

Think: do you have any idea of how difficult it has been for LAWYERS to convince JUDGES in civil court that an act constituted abuse? The Justice Center came as a result of the inability of our courts to protect these people. A whole agency (CQCA) was banished for doing a terrible job, but some how A CLERK OVER THE PHONE WILL DO A BETTER JOB AT ASSESSING THAT A REPORT CONSTITUTE ABUSE!. I’m not screaming, I’m just highlighting!

I just don’t see it, how is this bill any better at preventing abuse. I’m waiting to get someone to enlighten me.

Re: NYS Law 7400 creating the Justice Center for the Protection of People with Special Needs#4


30 (d) all records of the proceedings, the deliberations of the justice center medical review board and any testimony given before the board shall not be subject to disclosure under article thirty-one of the civil practice law and rules.

 43 s 556. functions, powers and duties of the board. (a) make a preliminary determination whether the death of a patient or 47 resident in a residential facility within the meaning of subdivision 48 four of section four hundred eighty-eight of the social services law, 49 which has been brought to its attention is unusual or whether such death 50 reasonably appears to have resulted from other than natural causes and51 warrants investigation;

The first quote from the new law tells you that the deliberations of the medical review board are closed to you just like an Inquisition, they are SECRET. The second quote tells you that you have no right to see on what basis their determinations about a death of a person under a provider’s care doesn’t warrant investigation. Well, it doesn’t say so, you just have to put the first quote together with the second to arrive to that logical conclusion. If the deliberations of the board are secret, “not subject to disclosure”, and they decide that a death doesn’t warrant investigation but you think it does, you can’t challenge their determination because you don’t know what it’s based on. Maybe you can challenge but it will be blindly because you don’t know which facts to challenge. And since you have no right to sue because there’s no cause of action allowed nor sue for damages, you are basically out of luck (assuming you are the living person).

So, what is this law achieving in terms of your rights to determine whether a loved one died due to negligence of the provider? Nothing. It only PROTECTS THE PERPETRATORS.

As I continue reading, I will make any corrections on my interpretations based on other facts I find in the many pages.

Re: NYS Law 7400 creating the Justice Center for the Protection of People with Special Needs#3


s 553. powers and duties of the justice center. the justice center shall have the following powers and duties:
(d) consistent with appropriate collective bargaining agreements,
conducting all hearings and other proceedings relating to discipline of employees found to have committed abuse or neglect (for state entities bound by collective bargaining, the disciplinary process established through collective bargaining shall govern);

What this is saying is that, despite all of those hundreds of pages of new law to supposedly prosecute abusive workers, the unions determine how to deal with the perpetrator. It says so clearly: “IT SHALL GOVERN”, collective bargaining rules!

Now, if I were a unionized worker, I would want that in there. Honestly speaking, that’s their right, to protect each other, to have that union protect them. The government is not going to protect them, that’s why workers pay the union, for protection. I have no problem with that.

My problem is that NO ONE WAS REPRESENTING US CONSUMERS, the ones for whom this bureaucracy was being enacted, there. This was all done between politicians and the unions.

That’s why I keep insisting in that the ONLY mechanism mental health consumers have to protect themselves are the CONSUMER ADVISORY BOARDS in each program, if they can make it work for them. That’s what the Citywide Mental Health Project is trying to do: train ourselves to use the CABs for what it was meant to be.

Our power is in our number. The good intentioned lawyers who have represented us in court can’t protect us. We lost almost every case in court for the protection of people been abused, lost in appeals.

Maybe we need our own ‘union’.