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.

After Henderson saw the memo, he asked Sell to monitor the audit of the agency that ComCare began on March 30, 1994.

Sell describes the ComCare audit as one of the most blatantly biased he has ever seen. Although he hadn't been aware of the political battles between LDI and ComCare, he knew something was wrong.

"The whole thing was a joke," Sell said. "They would set one criteria, then if they didn't like the results, they would change the criteria. Basically, it smelled of just trying to get something on Living Dynamics."

Sell says the audit was so slipshod, on the last day he observed members of the ComCare audit team literally flipping coins to determine whether specific bills should be paid.

Sell is convinced the audit "was an attempt just to put them [LDI] out of business. I think the audit was constructed and intended to come up with some astronomical claim against Living Dynamics. There isn't any other conclusion that could be drawn from it."

Despite Sell's claims of a prejudicial audit and that ComCare's lax accounting had helped Galloway commit crimes, ComCare branded LDI the culprit and canceled its contract.

Yet Galloway was the only person charged with a crime. After a lengthy investigation, Phoenix police and Maricopa County prosecutors listed LDI as a victim, not an accomplice to Galloway's fraud.

On October 24, 1994, Galloway pleaded guilty to felony counts of theft and criminal damage. He is serving a five-year prison sentence.

Henderson is struggling to reestablish LDI. He was able to bring the firm out of Chapter 11 in May.

A Client on Trial
In late 1993, a mentally ill, suicidal, HIV-positive man named Phil Girardin filed a complaint against ComCare.

Girardin claimed he'd been treated poorly during a crisis, that his incessant cries for help had been ignored. ComCare had provided him inconsistent or nonexistent care for months, he also alleged.

DHS' Office of Human Rights got involved after Girardin expressed dissatisfaction with ComCare's response to his grievances. Pat Pugliese, an advocate at the office, was assigned to help Girardin.

She soon discovered that the Girardin case had touched a nerve with ComCare. From its president down, the firm made it known that interference from the Office of Human Rights--created in part to make certain ComCare does its job--would not be tolerated.

DHS opened the Office of Human Rights in October 1993. One of its undertakings: Guide the seriously mentally ill through the mazelike appeals and grievances processes.

The idea is noble: "To provide independent oversight of claims of illegal, dangerous or inhumane treatment of persons receiving mental-health services and [of] legal rights violations."

But the Office of Human Rights was shackled financially from the start. The Arizona Legislature appropriated only $228,000 for its first year. DHS asked lawmakers this year to give the office a much-needed financial boost, from $228,000 to $655,000. They didn't add a cent.

"We were overworked, but we had a gung-ho attitude," says Pugliese, one of the office's four original advocates. "We thought we could make a difference, no matter the odds."

Pugliese is a diminutive single mother in her mid-30s, a feisty blend of compassion and determination; the job of advocate seemed a perfect fit.

"Most people get into social work because they care," she says. "As an ex-case manager, I had run into many folks who had a snowball's chance of being able to even ask for help when they needed it. I wanted to help those people."

Pugliese is outspoken, as Human Rights chief Bob Farmer soon learned.
"I asked Bob early on, 'How are you going to resolve the intrinsic conflict of interest of an agency [DHS] in effect policing itself?'" she says. "He said, 'Patty, there will be no conflict. We're directly under the director and we'll be given a free hand. Call it like you see it.'"

But Pugliese says Farmer soon warned her that rocking the boat could backfire on her. The notion of an advocate not rocking the boat baffled her.

"I worked with some fine people at ComCare," says Pugliese. "They have some people you can negotiate with--`Do this for my guy and I'll be out of your hair' sort of thing. Sometimes, you just have to tell your client that there's no way to get him what he wants. But there's other times when you have to fight for someone, do whatever it takes."

Phil Girardin was one of those clients.
Records show Pugliese became Girardin's advocate in late 1993. He was diagnosed as seriously mentally ill in 1992 after a suicide attempt, and his life was a disaster: Doctors had diagnosed him in 1992 as HIV-positive. His personal life was in constant turmoil.

"Talking to me at times is like talking to a really healthy vegetable," says the 28-year-old Girardin, chuckling briefly at his own plight. "But sometimes, I'm not so healthy."

November 1993 apparently was one of those times: "I had just found out I was on the edge of full-blown AIDS. I was stressed. I needed help. I left six messages for my ComCare psychiatrist, but he never called me back. I told my new case manager that I was suicidal because I was. He said I could see a psychiatrist in a week."

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