MENTAL HEALTH MASQUERADE

ARIZONA SET OUT TO CREATE THE BEST MENTAL-HEALTH-CARE SYSTEM MONEY COULD BUY. IT ENDED UP WITH A PROGRAM AS DYSFUNCTIONAL AS THE PEOPLE IT SERVES.

Hyde's first priorities included derailing the push at the Legislature to move mental-health responsibilities from the middlemen firms such as hers to AHCCCS.

Proponents of the change pointed to a federal study that revealed gaping holes in Arizona's system. "Accountability is spread among so many agencies that it is difficult to fix responsibility," it concluded. "When things go wrong, they are impossible to correct, because it is always 'someone else's responsibility.'"

One of the most persuasive witnesses for maintaining the status quo was court monitor Glenn. She also wrote a glowing early review of Pam Hyde in her May 1994 Blueprint update.

In the end, the lawmakers voted against the switch.
Victory in hand, Hyde turned her attention to the deficit and to ComCare's tattered image. By the spring of 1994, the firm had found an avenue to solidify its shaky position. It became known as "the LDI mess."

The Rise and Fall of LDI
On April 22, 1995, 24-year-old Heather hit bottom.
Her body wracked by neuromuscular disease and her mind twisted by depression, she steered her wheelchair into her kitchen, took a paring knife and cut 12 parallel grooves into the fleshy white skin on her upper right forearm.

A crisis team responded. The mutilation wasn't a suicide attempt, she told the team, it was an attempt to transfer her pain from the inside to the outside.

Heather and her husband, Lee, a 36-year-old quadriplegic, are ComCare clients. Lee is so depressed he dreads waking up in the morning. He spends most of his days in a stupor, a 98-pound man sitting naked in a wheelchair.

Until April 1994, Heather and Lee had attended weekly therapy sessions through Living Dynamics Incorporated (LDI), a large Valley agency which had a contract to serve as a ComCare provider.

But that changed when ComCare canceled its contract with LDI. The resulting upheaval meant that the couple and hundreds of other seriously mentally ill patients lost their therapists, at least temporarily. Some were placed on waiting lists and left to fend for themselves for months.

Heather and Lee had developed a strong bond with their LDI therapist, who spent an hour a week with each, and another hour providing joint marriage counseling.

The LDI therapist came to the couple's home, which Heather says made her feel safe and comfortable. Lee recalls he was happier and better able to cope. Their therapist also was a licensed nurse sensitive to their physical handicaps.

Heather says ComCare offered her reduced services at a distant counseling center six weeks after her final session with her LDI therapist. She told ComCare she needed in-home counseling because she couldn't get around. Lee also scheduled an appointment with ComCare, but was ill, and missed it.

The couple claim ComCare practically ignored them for the rest of 1994.
Lee would go without therapy for more than a year.
But Heather couldn't wait that long. In January 1995, after eight months without therapy, her anger overcame her fear of venturing out. She rode buses during a 90-minute trek to the ComCare office and demanded treatment. ComCare offered her the minimum--two hourlong therapy sessions a month--a third of what she had had under LDI.

She says it took ComCare a month to find her a therapist.
"I said that I was going to reserve my trust until I knew what ComCare was going to do with me," she says.

Her skepticism was justified. Since January, she's had only four hours of counseling--from three different therapists.

As Heather and Lee deteriorated, ComCare pocketed thousands of dollars paid by the government to treat them. It hasn't always been that way; since July 1994, the state has allowed ComCare to use money not spent for treatment to reduce its deficit. Prior to that, ComCare was required to refund money not spent on treatment.

From July through September alone, ComCare officials estimate, this new arrangement allowed the company to trim its deficit by $700,000.

The cost-cutting ploy backfired in Heather's case--she eventually required intensive treatment.

In all, she took a knife to her flesh three times, slashing her arm, knee and hand and finally puncturing a vein in her wrist. She wound up spending 22 hours at ComCare urgent-care centers and received two expensive visits from a crisis intervention team.

In late May, she was admitted to a hospital psychiatric ward for a week. She says she was hospitalized because she wouldn't promise doctors she'd stop hurting herself and she couldn't stop thinking about hurting her husband.

Lee says he plans to divorce Heather.

LDI lost its contract at a pivotal time during ComCare's history.
ComCare was hemorrhaging millions in red ink, and the Legislature was threatening to shift ComCare's duties to AHCCCS. At the same time, LDI was in a period of rapid expansion, on the verge of becoming a big enough player to challenge ComCare's supremacy.

ComCare officials say the shuttering of LDI was a prudent response to embezzlement committed by an LDI accountant. LDI also kept shoddy records, ComCare alleges.

LDI supporters contend ComCare used the embezzlement and a subsequent audit as a pretext to destroy LDI and further ComCare's own political and financial ends. They concede the embezzlement was a legitimate problem, but not one that required ComCare to drive LDI into bankruptcy.

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