Union employees with Behavioral Heath Resources say that while systemic change is needed to resolve all of the issues within BHR, mismanagement, a “shame and blame” atmosphere, wages demands and cuts to medical benefits are all reasons for their current labor problems. A three-day strike is planned for Friday, March 14.
BHR is Grays Harbor County’s main provider of mental health and addiction services. The agency also serves Thurston and Mason counties.
The Service Employees International Union Healthcare Local 1199NW says attempts to work with management have been ignored. The claim from BHR CEO John Masterson that the local was unwilling to meet with them in June to discuss changes to BHR’s medical plan is “simply untrue,” according to Rita Niles, the union delegate for Grays Harbor County. She has worked for BHR in Hoquiam for the past seven years. They also say the impasse declared by BHR several months ago after their last bargaining session, was done “illegally” while the union was still under the impression it was bargaining.
Masterson said BHR determined the parties were “deadlocked on any substantive and real steps” to deal with BHR’s fiscal crisis and that the federal mediator present conveyed the message to SEIU 1199NW after its decision. Both parties will meet again to bargain on March 12, but Niles said she thinks the underlying issue is a need for systemic change, and that the discussions will be “going on for sometime.”
“Morale is at an all-time low … right now it’s a hostile work environment,” said Niles, adding BHR clinicians on Grays Harbor are “exhausted and disheartened” from “verbal abuse” and that many of the most-skilled among them have left for other jobs, or are planning to leave due to the issues.
Blame for “no-show” rates which are “absolutely typical” in the mental health industry, have been placed on clinicians in a “very punitive way,” she said, adding that while clinicians are still paid by BHR when clients do not show for appointments, they are still required to make up those hours. They must reach a quota of 1080 hours, a number that rose from from 900 in July of 2011 during a collective bargaining agreement with SEIU in 2011. It is anticipated that the state will look to increase it yet again.
“(Management) is saying, ‘something is wrong with you if you can’t reach these hours, it’s your lack of skills, it’s something going on in your personal life,’ ” said Niles, adding clinicians are being told,”if you can’t stand the pressure find another job.”
Masterson said he is unaware of such things being said and that there is a process for addressing such grievances. Asked to respond to Niles’ comments that the majority of blame falls on clinicians for the missing hours that have contributed to the agency’s financial troubles — Masterson said his “energy isn’t focused on looking backwards,” but on “solutions.”
Much of BHR’s funding comes from Grays Harbor County, which contracts with the agency to provide services.
A central issue in the agency’s funding problems is that the county pays BHR for the services it performs, not in a lump sum contract as it once did. When a client doesn’t show up for an appointment, BHR isn’t paid. But the clinician must still be paid by BHR.
In a letter to county commissioners BHR psychiatrist, Dr. Tim Truschel, described “the uniquely problematic issue of no shows, as it exists in (the mental health industry’s) clinical reality.” Truschel cites one of his 9-hour days in Elma, where he visits only once every two weeks, and a total of 5 clients who were no-shows that day, due to numerous reasons ranging from being “too disorganized to remember” or being “in the ER all night.” He said mandated work, including fielding emails, checking notes, writing prescriptions and writing detailed notes for documentation are not currently billable, but necessary work that he is expected to complete in his “down time.”
“None of that time in the current contract is billable,” Truschel wrote. “But all of it, 100 percent, is professionally necessary. Doing anything less is malpractice.”
He notes “disciplinary measures” threatened by administration if he does not meet his “face to face” time, and his labeling as a “deficient producer” if he is unable to meet the 5.6 hours he is instructed by administration to collect during a 9-hour work day.
“The expectation of the (county-run Regional Support Networks) and BHR administration that we exert ultimate control of ‘face to face’ productivity has become seriously unmoored from what happens in real time,” he wrote, adding that even more difficult for the staff is the “complete absence of respect for the quality and execution of (their) job,” one which is “precisely to collect the less than compliant patients before they wreak havoc in our communities.”
Niles said she has spent time lobbying in Olympia arguing against the fee-for-service model that counties like Grays Harbor County use in favor of as opposed to the block grants — like BHR was given by the county during their first year there. Currently, only about 40 percent of the agency’s costs are such grants, the rest are fee-for-service, according to Masterson.
“Mental health is a very complex service that we provide and this fee-for-service is just not working,” said Niles, adding state legislators are beginning to understand that cuts to mental health funding during the recession were excessive and are seeing the result in places like jails and emergency rooms. It is currently working on broad reform, and is examining proposals to aid in it, looking at integration of the public mental-health system with chemical dependency treatment and primary care — and are looking to convene a task force in April to examine reform of the adult behavioral health system.
The idea purported by county health officials that block grants can be a disincentive for performance and make it difficult to determine performance metrics — as was reported by The Vidette, citing Grays Harbor Public Health Director Joan Brewster, is not a good argument in the context of the mental health industry, argues Niles.
“The people who come into mental health profession do so because they’re caregivers … they want to see their clients succeed,” she said, adding they “certainly don’t stay for the pay.” “Rewards are sometimes few and far between … Employees don’t stay if they don’t have the heart for this business. They want to do the best they can, but it makes it difficult when they’re being hit with a stick.”
Another example of “mismanagement” Niles cites is the direction to bill certain services, like group trips, which she said led to the need for BHR to pay back $446,000 to Thurston County for improper billing — a large part of the agency’s current financial crisis.
“We were told groups are where the money is, that everybody needs to be doing groups,” she said, adding that the practice of such socialization is important for mental health patients, but that it was not properly documented as being tied back to medical necessity. “It doesn’t mean that our clients didn’t benefit from those services, but they weren’t managed or documented properly.”
Masterson said he is focused on looking at the current conversation, and does not find it beneficial “looking backwards and trying to place blame” in regards to the group services issues he said were addressed in 2012 and 2013. But, Niles said that the “lack of confidence” in management currently held by union members, starts with direction from Masterson.
“The employees feel that it’s coming from the CEO down,” she said.
Niles said BHR union members, including herself have tried to meet with Grays Harbor County commissioners — who approved an amendment to BHR’s contract Monday. The contract is for services from April to September of 2014, which is estimated to bring in an extra $125,000 for BHR, Grays Harbor Public Health Director Joan Brewster told The Vidette.
Commission Chairman Frank Gordan told Niles he would meet with her in the beginning of February after BHR delayed payday and told employees they may have to close, she said, but then received an email that he would not — citing an effort to stay neutral. The Vidette cited a request by Brewster for the commissioners not to meet with union members, and Brewster was unavailable for comment regarding the request on Friday.
“I was pretty upset, because I am a taxpayer — I pay part of my own wages, in fact. We have the right to be heard,” said Niles of her attempts to meet with Gordon.
Gordon told The Daily World Friday that he is willing to meet with Niles if she understands his inability to influence decisions made regarding BHR. Niles said she does understand that, but that she thinks “someone needs to take a closer look” at management issues within BHR.
SEIU Healthcare Local 1199NW, which represents 96 full-time, 52 part-time and 32 on-call staff members with BHR, plan to picket at BHR’s office in Hoquiam, Elma and Olympia starting at 8 a.m. on Friday and ending Monday, March 17 at 7:59 p.m. BHR’s 24-hour crisis center and its related hotline will continue to be operated during the strike.
Sam Luvisi: 360-537-3935 or firstname.lastname@example.org and @Dw_Sluvisi on Twitter