As Colorado embarks on a new attempt to reform the supply community for psychological well being care within the state, the occasions of 2014 supply a take a look at how tough it may be to impose change on the politically related, deeply-entrenched group of community-based suppliers which have managed the system for many years.
That yr, everybody from the governor to the pinnacle of the state Division of Human Companies and legislative leaders introduced their intention to alter the system and improve entry to psychiatric take care of poor Coloradans in disaster.
However after a bid was awarded to a brand new supplier with an modern plan, the state reversed course, sweeping apart their declared need for reform and difficult their very own bid procedures. Then, when the successful bidder additionally received in court docket, the present suppliers stepped in, settling the case, tightening their maintain on psychological well being therapy within the state and seemingly completely eliminating the largest menace to their dominance they’d ever confronted.
Specialists on the state who had lengthy labored for change had been crushed.
“That was essentially the most tough, in all probability, time in my profession I’ve ever had,” stated Chris Habgood, a former staffer on the state Division of Human Companies who wrote the plan for change within the 2014 effort. “As a result of when you understand you’re doing one thing that’s the proper factor to do, to assist folks, you are so enthusiastic about creating this new system that can assist Coloradans.
“After which unexpectedly it involves a crashing halt as a result of the service supply system did not like what the result was … there’s winners and losers, and the losers did not like shedding they usually had been gonna guarantee that they weren’t the losers.”
In partnership with COLab and information organizations throughout the state, CPR Information has spent months analyzing how Colorado’s system for treating people who find themselves each poor and mentally in poor health got here to be, and the way it has survived challenges to its construction.
Previous stories from the consortium have proven how among the state’s 17 community-based psychological well being suppliers have failed to offer therapy to the hardest and costliest instances whereas avoiding competitors.
And whereas the businesses level out that hundreds of individuals are helped by the system annually, research have proven that Colorado has the very best price of grownup psychological sickness within the nation and one of many lowest charges of entry to care.
George DelGrosso, who in 2014 oversaw the Colorado Behavioral Well being Council, the lobbying group that represents the present suppliers, didn’t return a number of messages searching for remark. Doyle Forrestal, who took over from DelGrosso as head of the CBHC in 2015, stated she believes the phrases of the 2014 settlement preclude her from commenting on it. She declined an interview, and claimed it was illegal to debate particulars of the facilities’ secret settlement to stifle the competitor.
The present head of the Jefferson Middle for Psychological Well being, which was among the many facilities that drove the settlement, famous that it occurred beneath earlier management, and questioned why CPR Information and COLab had been persevering with to look at the efficiency and historical past of the present suppliers.
“It appears there exists an intent to hurt the integrity and status of neighborhood psychological well being facilities, at a time when it’s vital that we stay out there to hundreds of individuals in our neighborhood who want and belief the care we offer,” wrote Kiara Kuenzler, president and CEO of the Jefferson Middle for Psychological Well being, in an electronic mail to CPR Information. “Jefferson Middle serves greater than 25,000 folks annually, and CMHCs serve greater than 200,000 folks throughout Colorado annually.”
“Now we have an obligation…”
On Dec. 18. 2012, 5 months after the Aurora theater capturing and on the eve of the state legislative session, Hickenlooper stood in entrance of the media and introduced the plan to revamp psychological well being therapy within the state.
“Now we have an obligation to take a look at how we assist one another,” stated Hickenlooper. “I consider these insurance policies will scale back the chance of unhealthy issues occurring to good folks.”
The information caught the eye of David Covington, an government at a behavioral well being firm in Phoenix, AZ.
“This was a nationwide story,” Covington informed a Denver District Court docket choose in 2014, in accordance with court docket recordings obtained by CPR Information. Covington testified that Hickenlooper and his crew “actually needed innovative. They had been searching for innovation. They needed neighborhood collaboration in a approach that they hadn’t seen earlier than. I believe that was what actually attracted us to this chance.”
Hart Van Denburg/CPR InformationCovington had spent a profession in psychological well being providers, beginning as a licensed counselor, working his approach as much as an government position with Magellan Well being Companies, which had the contract to serve Maricopa County, protecting Phoenix. At one level they served 100,000 lively purchasers within the county.
However Covington, after listening to information of what Hickenlooper needed to do, determined Colorado can be his new dwelling.
“We thought that is the place the nation’s going,” stated Covington. “That is what folks will probably be taking a look at. So we needed to carry the A-team to that.”
That might first require some gymnastics on Covington’s half. Habgood stated that in response to the lobbying by the present suppliers as the brand new laws labored its approach by the Basic Meeting in 2013, the state can be restricted to choosing solely a Colorado-based firm to offer the disaster providers known as for and funded within the new invoice.
So Covington testified he tapped the very best in psychological well being disaster providers throughout the nation and collectively shaped a Colorado firm known as Disaster Entry of Colorado. He tendered his resignation from the Arizona firm, so his resume could possibly be added to the proposal to Colorado.
His gamble paid off.
On Oct. 16, 2013, Colorado knowledgeable Covington that Disaster Entry had received the bid.
In an inner letter on the Colorado Division of Human Companies, Habgood wrote to the pinnacle of procurement, “the Committee discovered Disaster Entry of Colorado’s proposals to be essentially the most modern, built-in and recovery-focused proposals for reworking Colorado disaster supply throughout the state.”
A secrecy provision binds the events from the 2014 swimsuit, and Covington stated he couldn’t remark. However he informed the court docket that he wasted little time.
“Instantly we had been on the bottom right here,” Covington testified. “I used to be taking a look at homes to maneuver right here, taking a look at colleges, starting to craft out how we’d have interaction staff within the hiring of 150 to 200 plus employees right here in Colorado.”
Two weeks later the euphoria of the discover of award of contract would come crashing down. Covington was informed first that the request for proposals course of was beneath investigation by the state, and inside weeks he was knowledgeable he wouldn’t get the contract, that this system would exit to bid once more.
He was additionally knowledgeable that his rivals – the state’s present facilities – received a replica of his full proposal, however he couldn’t get a replica of theirs.
“It was very irritating,” testified Covington. “We had rigorously thought out what we hoped can be a successful technique, and put collectively corporations, took their distinctive product strains and melded them into one thing that had by no means been completed earlier than.
“And that aggressive benefit was now out there to entities that had completed second to us in these 4 areas. So it felt like our aggressive benefit was fully eradicated by what appeared like a really unfair course of.”
So Covington sued the Colorado Division of Human Companies to cease one other bid course of. What resulted, in accordance with testimony reviewed by CPR Information, was a weird alignment of shifting pursuits through which the identical state company that needed aggressive bidding argued that its personal course of was flawed. On the identical time, the state’s present facilities that misplaced the bid functioned as shadow defendants unnamed within the swimsuit, however supporting the state’s authorized technique. In the end they settled the case themselves within the secret settlement.
“Getting a lot stress from the Governor’s workplace”
Nearly from the second the legislature voted to require the brand new program to be competitively bid, there was concern on the state concerning the response of the present facilities, represented by the Colorado Behavioral Well being Council, CBHC, and its highly effective chief, George DelGrosso.
Shortly after the state introduced Covington’s firm received the bid, an electronic mail got here into Habgood’s inbox from his boss Patrick Fox, who wrote, “Who’s going to speak to George?”
The shedding bidders made up DelGrosso’s board, representing facilities from each nook of the state: AspenPoint (now Diversus Well being), Neighborhood Disaster Connection (a gaggle comprised of the metro space facilities), Northeast Behavioral, and an affiliate of Thoughts Springs.
Harriet Corridor, who ran the Jefferson Middle for Psychological Well being on the time and was a part of the Neighborhood Disaster Connection group that bid on the disaster program despatched an electronic mail to supporters, saying “We’re exploring all authorized choices for assessment of the awards course of…”
At stake was a disaster program that on the time was projected so as to add about $45 million in new cash for providers, only for the primary two years. However past that, the entry of Covington’s new firm right into a market that had been managed by the community-based facilities for many years promised to disrupt the supply of psychological well being care in Colorado in new and unpredictable methods.
Emails entered as proof together with testimony in Covington’s swimsuit point out that the teams used their internet of political connections to place stress on the Division of Human Companies and the governor’s workplace to kill Covington’s modern proposal, in accordance with Covington’s attorneys.
The chief of Human Companies on the time, Bicha, rapidly ordered a assessment of the RFP course of by a separate state company, the Division of Personnel and Administration. The company produced a brief, one web page abstract of its findings, which CDHS relied upon to cancel the bid award, in accordance with proof offered in court docket.
The Denver District Court docket choose discovered the abstract to be “trumped up” by the state in a deliberate effort to overturn the bid. The total DPA investigation wasn’t delivered to Bicha till after the RFP was invalidated.
Covington’s lawyer, Todd Miller, counting on electronic mail proof, supplied his principle to a Denver choose of why the division did that.
Management at CDHS had been “getting a lot stress from the Governor’s workplace, that every one they needed was some beauty cowl, which they thought they’d in that one web page abstract to cancel.”
Individuals who had been part of scoring the bids had been stunned when there have been instantly considerations.
Chris Olson, then the chief director of the County Sheriffs of Colorado was on the RFP committee. Regulation enforcement officers tracked the method carefully as a result of, till that time, deputies and cops had typically been accountable for coping with and transporting folks present process psychological well being crises. He remembers an interview he did with state investigators from DPA.
“Gave them just about what I am telling you proper now,” stated Olson in an interview. “That I believed it was a good course of and that we weren’t motivated politically on this. And, yeah, the out-of-state agency received it. I imply, there’s nothing flawed with that. That is simply, they received the bid.”
Regardless of the lopsided scores in favor of Disaster Entry of Colorado, David Covington’s firm, and regardless of the individuals within the RFP committee on the state feeling that it was clearly a good course of, management at CDHS canceled the RFP and introduced they had been placing it out for bid once more.
The present facilities declared victory, sending out an electronic mail thanking supporters for placing on the stress. Harriet Corridor, on the Jefferson Middle for Psychological Well being, wrote: “I do know that a lot of you expressed your concern to CDHS and/or the Governor’s workplace, and I wish to thanks for this. I consider that the considerations expressed by a lot of you and the sturdy neighborhood help had been very important to this answer.”
Although the extra funding and creation of a brand new system for delivering disaster psychological well being providers was a signature initiative for Hickenlooper, those that ran his workplace stated they couldn’t recall a lot, if something, about how the 2014 effort unraveled.
In an interview, Roxane White, Gov. Hickenlooper’s chief of employees on the time couldn’t recall something concerning the episode.
She instructed reaching out to Hickenlooper’s then-chief technique officer, Alan Salazar, who’s now chief of employees to the Denver mayor. Salazar additionally couldn’t recall something concerning the disaster providers controversy. He instructed Katherine Blair Mulready, who was a well being care specialist in Hickenlooper’s workplace.
“I keep in mind that the unique bid was given to an out-of-state entity with out an present footprint in Colorado,” stated Mulready, in an electronic mail. “And that when that was introduced, the neighborhood psychological well being facilities had been very upset. Whereas I don’t bear in mind any particular conversations on this subject, I spoke with management of CBHC – the commerce affiliation for the CMHCs/BHOs – regularly throughout my tenure within the Gov’s Workplace (2011-2014), and the problem could have come up in discussions with them.”
Stress was intense from the state legislature too. Then-state senator Irene Aguilar who sponsored the legislation that directed cash to this system despatched emails that made their solution to the Division of Human Companies that had been described in testimony as pointed. It’s unknown precisely what she stated, but it surely was revealed in court docket that it helped immediate particular inquiries within the inner assessment. Aguilar didn’t reply to a number of requests for remark. Her emails had been launched as displays however are not within the court docket file.
In court docket, Covington’s attorneys targeted on the influence of Aguilar’s considerations, which had been forwarded down the chain of command at CDHS to Clint Woodruff, lead of the Division of Monetary Companies, who formally initiated the DPA assessment and in the end invalidated the bid.
“Significantly Senator Aguilar’s electronic mail,” stated Todd Miller, Covington’s lawyer in closing arguments on the preliminary injunction. “That very day, unexpectedly, we get a discover that the DPA goes to be requested to assessment this factor, and an electronic mail that claims ‘Clint, make sure when the DPA seems to be at this, they care for Senator Aguilar’s considerations.’”
In an interview, Woodruff denied there have been any political motivations behind invalidating the bid. “I used to be requested to do a assessment simply because it was some huge cash,” stated Woodruff. “It was a really vital invoice, proper?”
Woodruff stated that the request to assessment the bid got here from his boss on the time Susan Beckman, and he maintains that there have been deadly flaws within the course of and the bid deserved to be invalidated.
A number of messages left at telephones listed as belonging to Beckman weren’t returned.
Emails additionally got here from Dean Toda, who dealt with media for the State Home Democrats on the time, checking on the standing of the bid.
CPR tried to acquire copies of the emails, however the displays couldn’t be positioned by the court docket.
“a manufactured motive”
After listening to testimony over 4 days in early 2014, the choose agreed with Covington’s attorneys and issued a preliminary injunction to cease the second RFP from going ahead.
The choose stated from the bench that the state’s cancellation of the primary RFP, “simply defies motive … and it does recommend a manufactured motive to cancel, a trumped up motive, no matter you wish to name it.”
The choose additionally known as out the state for giving copies of Covington’s successful bid to the shedding bidders, permitting the present facilities to doubtlessly incorporate his already state-endorsed concepts into their proposal.
Bicha, in an interview with CPR Information, disputed that there was any outdoors stress, from the present facilities or the governor’s workplace to overturn the bid outcomes.
“No, there wasn’t stress to do it from outdoors. The stress was internally and mine,” stated Bicha. “I had considerations about their approaches and methodologies. And so I requested DPA, ‘would you independently assessment the work that my crew had completed, as a result of I did not have confidence in what I used to be seeing.’ In order that was the character of the request of DPA. There was no political stress.”
(AP Picture/Brennan Linsley)
Regardless of the motivation, disaster psychological well being providers had been now on maintain after the preliminary injunction. The state and the present facilities appealed all the way in which to the state supreme court docket, however the appeals had been all denied.
The state and the facilities entered into mediation with Covington and his firm Disaster Entry to hunt a settlement.
Ultimately, he agreed to drop his lawsuit so long as a “separate settlement” was reached between the present facilities and his firm, Disaster Entry. The separate settlement just isn’t a state report, and never topic to open data legal guidelines. It’s unknown how a lot, or even when, the facilities paid Disaster Entry to drop the declare in opposition to the state.
Additionally unknown: The place any funds that may have been paid to Disaster Entry would have originated. The facilities and CBHC refused to say, citing the non-disclosure settlement. The publicly out there tax returns for the non-profit facilities concerned, which derive their income from a mixture of state, federal and personal funds, replicate no funds to settle claims. The facilities refused to reveal the phrases to CPR Information.
What is understood is that, although his division was a defendant within the case, Bicha was not within the assembly outdoors of court docket when the deal was reached between the facilities and Disaster Entry. The case simply went away.
“From our perspective what occurred was the 2 of them reached some type of settlement,” stated Bicha. “We by no means had been notified of what the phrases had been. All we all know is that the lawsuit’s going away.”
Requested if he had questions concerning the nature of the settlement, Bicha stated, “Completely, however we had no proper to seek out out what the settlement was,” because it was settled between two non-public events in mediation.
However even whereas arguing that he needed the system to alter and that he had little selection within the selections surrounding the disaster care contract in 2014, Bicha additionally nonetheless questions your entire construction of behavioral well being supply within the state, because the legislature tries to start a realignment.
“These nonprofit firms have assured no-compete contracts with the state,” stated Bicha. “However they do not have accompanying transparency into their financials, into lawsuit settlements, to board appointments, into all of these different elements that the general public ought to have the ability to see and learn about if they will get practically solely state and federal {dollars} in no compete contracts.”
David Covington stated he couldn’t remark. He now runs a extensively revered disaster psychological well being providers firm known as RI Worldwide, primarily based in Arizona. The corporate has direct care providers in 9 states, however not Colorado. Covington and RI’s method is routinely cited in greatest observe tips by federal companies and nationwide behavioral well being associations.
Specialists within the subject stated the choice to reverse the award to Disaster Entry meant Colorado missed out a possibility to develop into a nationwide mannequin for disaster psychological well being care administration.
David Covington and RI Worldwide have, “actually been on the forefront of what a disaster system ought to appear like,” stated Dr. Amy Watson, a professor within the Social Work Division on the College of Wisconsin-Milwaukee.
Watson was stunned to listen to that Covington was basically kicked out of Colorado. “He actually has pushed issues ahead” in behavioral well being innovation.
With Covington out of the image, the state awarded the contracts and extra funding for disaster providers to the present facilities.
The facilities ran providers till they discovered themselves battling the state once more.
In 2018, Human Companies once more put the disaster providers out to bid. This time, the middle’s commerce group, CBHC, sued the state immediately, claiming modifications to the present system had been unneeded.
However by bringing this system again to court docket, it allowed for some unflattering testimony, making clear that the present facilities, particularly Thoughts Springs, which managed the disaster providers for the Western Slope, weren’t fulfilling key components of the 2014 contract they’d fought so onerous to win.
The assistant Summit County supervisor Sarah Vaine testified that she noticed a map as soon as that indicated the county had cellular psychological well being disaster providers, supplied by MindSprings.
“It says we have now this in our neighborhood,” testified Vaine, but it was not really out there locally.
The legal professional for CBHC and Thoughts Springs requested how Vaine knew that.
“It is primarily based on neighborhood expertise of calling the disaster line and being informed to go to the emergency middle after which having the CEO, and the native director, say ‘we cannot go to folks’s properties as a result of there could possibly be a threat to our employees.’ And I then stated, ‘nicely, you may name dispatch and ask for somebody to go along with you. They usually stated, that is not a part of our coverage.”
Staffers from the state’s Division of Human Companies stated that these issues had been actually widespread. Habgood stated in an interview that for all of the people who find themselves nicely served by the community-based facilities, there are nonetheless occasions after they fall quick.
“They do nice work. They actually do. They do serve folks rather well. And I wish to be very clear on that’s, and it is not simply cuz I had relationships with them,” Habgood stated. “There are people who find themselves being served. There are occasions the place they…they do not at all times do good.”
A Denver District Court docket choose dismissed the 2018 lawsuit from the bench, ruling on the slender grounds that the state is entitled to place packages out to bid in the event that they see match.
The facilities by no means bid on the brand new program. A gaggle of so-called Administrative Companies Organizations, or ASOs, now handle the state’s disaster providers. It was meant as a approach for the state to diversify away from the neighborhood psychological well being facilities a bit, however the facilities nonetheless present nearly all of psychological well being providers within the state by contracting with the ASOs.
Nonetheless, the lawsuit despatched a message.
“I believe it is an intimidation tactic, proper?” stated Nancy VanDeMark, the previous head of CDHS’s Workplace of Behavioral Well being. “When you make it so tough,” the state will assume twice about including competitors to the present facilities.
“And I believe it has been to some extent profitable.”
