By Amy Silverman
By Olivia LaVecchia
By Monica Alonzo and Stephen Lemons
By Chris Parker
By Michael Lacey
By Weston Phippen
Official grievances often grind through the system at a snail's pace. ComCare seeks to solve client gripes internally.
Some clients are pacified; others aren't.
But it should come as no surprise that many seriously mentally ill don't have the wherewithal to make it through the arduous process alone.
If a problem isn't resolved at the ComCare level, a client may appeal to the state. Ultimately, an issue may be decided at a so-called Fair Hearing.
There, a hearing officer selected by DHS considers testimony from both sides in a quasi-trial setting. The officer then makes recommendations to the DHS director--Jack Dillenberg--who has the final say.
Phil Girardin filed his grievance with ComCare in late December 1993. In March 1994, ComCare upheld two of his three complaints, admitting it hadn't provided the proper continuity of care to Girardin.
But the firm maintained it hadn't erred during Girardin's November crisis. That infuriated Girardin. He decided to appeal ComCare's decision to the state level. Pat Pugliese warned him victory could be hollow.
But Girardin was insistent, even after his mental state took an apparent turn for the worse last June.
"The grievance process can make being mentally ill a lot worse," he says. "But I just decided it was the right thing to do."
On the morning of June 10, 1994, Girardin asked Pugliese to come to his house. Worried, she did so. He asked her to answer his phone because he didn't want to converse with a ComCare case manager who was going to call.
Pugliese relayed Girardin's message when the case manager called.
That day, Bonnie Marsh, then the director of ComCare's Grievance and Appeals section, fired off a letter to Human Rights chief Bob Farmer.
"Pat Pugliese has seriously interfered with the case and service . . . to a ComCare seriously mentally ill individual," Marsh wrote. "I request that you immediately look into this situation and provide us with a response as to what is considered appropriate advocacy . . ."
Marsh demanded an answer in a second letter to Dillenberg. Company president Pam Hyde wrote one of her own.
Pugliese refuted ComCare's allegations in a long memo to Farmer. Girardin also penned a strongly worded statement: "Pat Pugliese has never interfered in any way with my treatment at ComCare. Ms. Pugliese never said that I shouldn't have contact with ComCare. . . . She is an advocate, not a detective or dictator for me or anyone involved."
But Bob Farmer didn't defend Pugliese. She says Farmer told her she was "playing in traffic," that the system would lose a good advocate if she persisted.
Pugliese's professional reputation was on the line. Last July 15, she wrote a letter to Farmer's boss, DHS director Dillenberg.
"My supervisor has been placed under tremendous pressure attempting to provide advocacy to a dysfunctional system resistant to change," Pugliese wrote. "It appears DHS may not be supportive of protecting client rights when uncomfortable issues arise."
On July 21, Dillenberg finally responded to Pam Hyde. Briefly, he defended Pugliese: "It is my understanding that [she] acted within her authority and according to the client's request in responding to your office as the client's advocate."
But instead of chiding Hyde, Dillenberg was conciliatory. He noted that his agency's goal "is to reduce the perception that this office acts solely as adversaries to the interests you and your staff have."
(Dillenberg canceled a scheduled interview with New Times to discuss this and other issues.) On July 22, Pugliese suffered injuries in a car accident caused during a diabetes-induced blackout. She went home to recuperate after a two-week hospital stay. But she continued to help Phil Girardin.
The mentally ill usually are at a disadvantage during Fair Hearings. Because few can afford attorneys, most represent themselves. Advocates can attend hearings, but are not allowed to speak for the record and may only whisper to their clients.
ComCare, on the other hand, employs private lawyers to do its bidding against its seriously mentally ill "adversaries."
The scenario can be daunting: Mentally unstable people must face off against attorneys bent on vindicating ComCare at any cost.
Pugliese realized she needed to find an attorney for Phil Girardin, even if she had to pay for one herself.
"I got sick and tired of seeing my clients being stepped on," she says, "and I knew Phil didn't have a prayer at the hearing without a lawyer."
She convinced Scottsdale attorney Harry Howe to represent Girardin at the Fair Hearing. Howe practices mostly insurance defense, not mental-health law, but he agreed to represent Girardin. Pat Pugliese says she paid Howe $1,000 out of her own pocket.
Howe quickly realized he'd become involved in something larger than he'd expected: "I'd kept telling Phil, 'We're talking about a toothless procedure here. Don't get too worked up.' But when the hearing started, there were about 14 people from ComCare sitting there, all intense. It was peculiar. The only thing I could figure was that ComCare was trying to teach Pat and the Office of Human Rights a lesson."
ComCare retained Phoenix attorney Joseph Rocco, an experienced hand in this type of proceeding.
"These hearings consume a lot of time and money that could go to treat people in need," Rocco says. "I think if the advocate had done her job properly, we wouldn't have even been there. . . . ComCare was very concerned that they were pushing this so they could file a lawsuit."