RE: Arizona Senate Bill 1450. The newly designated Independent Oversight Committee, Goddamned Bureaucracy, and Enter the Montana State Hospital.
The human rights INDEPENDENT OVERSIGHT committee on the mentally ill is established in the Arizona health care cost containment system DEPARTMENT OF ADMINISTRATION to promote the rights of persons who receive behavioral health services pursuant to title 36, chapters 5 and 34. (See below).
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Fired 2015.
Donna Noriega. ASH CEO.
Cory Nelson. Deputy Director ADHS/BHS
Jeff Bloomberg. ADHS staff attorney. |
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Dr. Cara Christ
Director.
Arizona Department
of Health Services.
January 2015-present. |
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Twice convicted (2009, 2012)
sexual predator of children,
former ASH security guard
Roger James Forney |
ARIZONA SENATE BILL 1450, VERSION 2018.
Below is a portion of the core elements of this bill, which was ratified by Arizona Governor Doug Ducey on April 20, 2018. Its purpose derives of findings specific to the attempt Dr. Cara Christ, Director of Arizona's Department of Health Services, and at least one Arizona Health Cost Containment staff attorney, Greg Honig, to dismantle the lawfully required presence of a citizen based body of on-site patient advocacy at Arizona State Hospital (ASH). This attempt is 100% consistent with patterns of corruption and related abuses of ASH patients, abject and utterly deplorable wrongdoing that state mental hospitals are well known for. While in the meantime, ASH itself has been the subject of no less then three formal interventions of the federal government over the least 15-18 years on the basis of this same range of issues; on large part due to the willingness of Hospital psychiatrists- all of whom were not the target of accountability in relation to these interventions- to turn a blind eye towards all/any evidence specific to staff misconduct and patient abuse.
As long time ASH psychiatrist Dr. Laxman Patel stated to me when I described occurrences of patient abuse and staff wrongdoing with him in our first three to four formal patient to primary attending care physician meetings:
"This is the state Hospital.
What do you expect?"
As though, merely on the basis of ASH being a state managed hospital facility assigned the responsibility to care for persons affected and disabled by mental illness, we the public should not expect to be provided the same level of treatment and preservation of (our) patient rights that any other hospital is required to provide. This is consistent with the known history of state mental hospitals, and Patel's attitude clarifies this in all terms. It is that simple.
I shit you not, the above is the verbatim response of a highly entrusted, state employed physician when I asked him to do something in defense of the rights of myself and my patient-peers at ASH in late January, 2011. An overtly inept doctor who- along with a horde of equally incompetent ASH medical staff- has never been included in the accountability processes at ASH, where on no less then three occasions in the last 15 years, this facility has been subject to direct federal oversight on the basis of identified substandard care practices and conditions. Deeply disturbing to know that this dimwit is still on the medical staff at ASH. But as far as Cara Christ and Aaron Bowen are concerned, no aspect of this shit is of legitimate attention.
"Center of Psychiatric Excellence" my ass.
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Former-since fled
ASH psychiatrist
Dr. Pervaiz Akhter |
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| Akhter today. |
Pervaiz Akhter was my second assigned primary care physician, assigned as such due to Patel's frustration over the fact that I refused to ignore his failure to meet his given responsibilities. Akhter is the most overtly abusive physician in any setting that I have ever encountered. Is it any coincidence that both he and Patel immigrated to USA from two of the most corrupted third world nations in history, India and Pakistan, attaining the right to practice medicine here through the federal J1 program? While both Dr. Ruby Ramos-Roxas and Dr. Sylvia Dy (two other ASH psychiatrists present during my time at ASH) come from the freaking Philippines? I think not.
All three of the above referenced third world nations are known as lacking in anything resembling legitimate democracy, and sites of abject abuses of human rights across the board.
The ASH Independent Oversight Committee.
Historically entitled the ASH Human Rights Committee, the author of SB 1450, Senator Nancy Barto, has retitled this group as an Independent Oversight Committee. The need for the term "independent" directly flows from the grossly unlawful manipulation, bullying, and outright threats directed to the members of this committee by Honig, in overt complicity with ASH CEO Dr. Aaron Bowen and ADHS Director Dr. Cara Christ. I contend that these people willfully chose to engage in such misconduct because they are just as committed to maintaining status quo (as applicable to patient abuse, staff misconduct and administrative corruption) that their immediate predecessors were involved in (the bulk of whom were summarily fired in spring 2015, and at least a couple of whom I feel should have been criminally charged for their roles in it all).
That said, the following is obviously not the final, fully revised version, and as said, is only one portion of the full SB 1450 document. But it should suffice for the moment. Read at will.
A. The human rights INDEPENDENT OVERSIGHT committee on the mentally ill is established in the Arizona health care cost containment system DEPARTMENT OF ADMINISTRATION to promote the rights of persons who receive behavioral health services pursuant to title 36, chapters 5 and 34.
B. Each region of this state covered by a regional behavioral health authority shall have at least one human rights INDEPENDENT OVERSIGHT committee with the authority and responsibilities as prescribed by the Arizona health care cost containment system administration DEPARTMENT OF ADMINISTRATION pursuant to rules adopted by the administrationDEPARTMENT relating to behavioral health services.
C. The director of the Arizona health care cost containment system administration DEPARTMENT may establish additional committees to serve persons who receive behavioral health services or to oversee the activities of any service provider.
D. Each committee established pursuant to this section shall consist of at least seven and not more than fifteen members appointed by the director of the Arizona health care cost containment system administration DEPARTMENT with expertise in at least one of the following areas:
1. Psychology.
2. Law.
3. Medicine.
4. Education.
5. Special education.
6. Social work.
7. Mental health.
8. Housing for the mentally ill.
9. Criminal justice.
10. Public safety.
E. Each human rights INDEPENDENT OVERSIGHT committee, if appropriate, shall include at least two parents of children who receive behavioral health services pursuant to title 36, chapter 34.
F. Each human rights INDEPENDENT OVERSIGHT committee shall include at least one member who is a current or former client of the behavioral health system.
G. Current or former providers or employees of providers that have contracted with a regional behavioral health authority may serve on a human rights AN INDEPENDENT OVERSIGHT committee BUT MAY NOT HOLD MORE THAN TWO POSITIONS ON THE COMMITTEE.
H. Each human rights INDEPENDENT OVERSIGHT committee may hold one or more community forums annually to receive comments regarding the experiences of individuals living with serious mental illness, and their family members and caregivers, across the care continuum.
I. The Arizona health care cost containment system administration DEPARTMENT shall ensure that each regional behavioral health authority and its providers develop and implement a human rights training plan to ensure that providers are trained regarding clients' human rights and the duties of the human rights INDEPENDENT OVERSIGHT committees.
J. Each committee shall be organized pursuant to this section and the requirements of section 41‑3804.
Sec. 10. Section 41-3804, Arizona Revised Statutes, is amended to read:
41-3804. Independent oversight committees; membership; duties; client information; immunity; violation; classification
A. Subject to the approval of the appropriate department director OF THE DEPARTMENT OF ADMINISTRATION, each committee established pursuant to this article shall adopt guidelines that govern its operation, including terms of members, quorum and attendance requirements and removal of a committee member if necessary. Each committee shall adopt these guidelines by majority vote within the first three months of its formation. These guidelines shall not conflict with this article. The director of the appropriate department shall approve the guidelines unless they are inconsistent with the department's statutes, policies, procedures or rules, or if the guidelines do not promote participation by all interested members of the community that the committee serves. In addition to the procedures in the guidelines, each human rights INDEPENDENT OVERSIGHT committee must approve the removal of any committee member on majority vote of the committee. The appropriate department director shall provide committee members the opportunity to review potential changes to rules or policies that affect the committee.
B. Employees of the department of economic security, the department of child safety, the Arizona health care cost containment system and the Arizona health care cost containment system administration and subject‑matter experts may serve on a committee only as nonvoting members whose presence is not counted for the purpose of determining a quorum.
C. Advocacy groups, local advisory councils, committee members and the director of the appropriate department may submit names of candidates to fill committee vacancies. The appropriate director shall appoint a person to fill a vacancy subject to the approval of the committee.
D. Each committee shall meet at least quarterly each calendar year.
E. Each committee shall provide independent oversight to:
1. Ensure that the rights of clients are protected.
2. Review incidents of possible abuse, neglect or denial of a client's rights.
3. Make recommendations to the appropriate department director and the legislature regarding laws, rules, policies, procedures and practices to ensure the protection of the rights of clients receiving behavioral health and developmental disability services.
F. Each committee shall submit written objections to specific problems or violations of client rights by department employees or service providers to the director of the appropriate department for review. The appropriate department director shall respond, in writing, to written objections within twenty‑one days after receiving the objections.
G. Each committee shall issue an annual report of its activities and recommendations for changes to the director of the appropriate department, the president of the senate, the speaker of the house of representatives and the chairpersons of the senate health and human services committee and the house of representatives health committee, or their successor committees.
H. A committee may request from the appropriate department the services of a consultant or department employee to advise it on specific issues. The consultant may be a member of another human rights INDEPENDENT OVERSIGHT committee, a department employee or a service provider. Subject to the availability of monies, the appropriate department shall assume the cost of the consultant. A consultant shall not participate in committee votes.
I. Subject to federal law, committee members and consultants have access to client information and records, including quality of care reports and, on request, case presentations, adult protective services investigation case status and outcomes, substantiations, recommendations and other quality of care findings from peer reviews or any successor report or process, maintained by the appropriate department, provider or regional behavioral health authorities to the extent necessary to conduct committee duties. Each person who receives information or records pursuant to this subsection shall maintain the information or records as confidential and sign an agreement to comply with all confidentiality requirements. Any client information or records shall be released to the committee without the designation of personally identifiable information unless the personally identifiable information is required for the official purposes of the committee. A violation of this subsection is a class 2 misdemeanor. For the purposes of this subsection, "personally identifiable information" includes a person's name, address, date of birth, social security number, tribal enrollment number, telephone or fax number, e‑mail address, social media identifier, driver license number, places of employment, school identification or military identification number or any other distinguishing characteristic that tends to identify a particular person.
J. If a committee's request for information or records from a THE department is denied, the committee may request in writing that the director of the appropriate department review this decision. The agency director or designee shall conduct the review within five business days after receiving the request for review. The agency DEPARTMENT shall bear the costs of conducting the review. A final agency decision made pursuant to this subsection is subject to judicial review pursuant to title 12, chapter 7, article 6. The agency DEPARTMENT shall not release any information or records during the period an appeal may be filed or is pending.
K. Confidential records and information received by the committee or its consultant are subject to the same provisions concerning subpoenas, discovery and use in legal actions as are the original records and information.
L. The human rights INDEPENDENT OVERSIGHT committees may exchange information and engage in planning and coordination activities between committee members in the performance of committee duties pursuant to this section.
M. The human rights INDEPENDENT OVERSIGHT committees may encourage public awareness and involvement in their activities by supporting committee members with affiliation agreements with postsecondary education‑sponsored internship placements pursuant to the appropriate department's approved operating procedures.
N. The appropriate departments DEPARTMENT shall coordinate education and training programs for committee members to facilitate their role as human rights INDEPENDENT OVERSIGHT committee members. The appropriate departments DEPARTMENT shall coordinate statewide meetings of committees at least every two years and provide staff for the committees.
O. Any person who, in good faith and without malice and in connection with duties or functions of a committee established pursuant to this article, takes an action or makes a decision or recommendation as a member or agent of a committee or who furnishes records, information or assistance that is related to the duties of a committee is not subject to liability for civil damages in consequence of that action. The court shall determine the presence of malice by clear and convincing evidence.
P. Title 38, chapter 3, article 8, relating to conflict of interest, applies to all committee members.
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OF GODDAMNED BUREAUCRACY.
"Bureaucracy, safely representing today
what it did yesterday, rolls on as ineluctably
as some vast computer,
which, once penetrated by error,
duplicates it forever."
Barbara Tuchman. Historian, author. (January 30, 1912- February 06, 1989).
One obvious feature to SB 1450 is its grindingly thick, hyper-technical language. This is common, however, and it takes a person trained and comfortable with negotiating the variously complex subsections and cross references, etc., to so much as survive reading it all. Therein, the nature of bureaucracy personified, so full of sand traps and loopholes that the lay public is typically left tearing at the roots of their hair (or worse yet, hiring a lawyer) when accessing these documents in the public record, or otherwise seeking to find their way through bureaucratic systems in general. No less problematic- this language- then bureaucratic systems in themselves, loaded to the hilt with complexity and near chaotic interplay between one given office of authority and any other in said systems, and thus all but impossible to directly serve the needs and interests of individuals.
The core problem, as well (arguably the largest problem), is that public health departments are filled with blatantly shortsighted bureaucrats. Persons well adjusted to the chaotic approaches to providing services, and comfortable with the fact that such systems are far less then useful to the lay public; designed, as such, to put the public out of touch with the ones most responsible for managing them.
This basic reality in relation to state managed mental hospitals, and other like public facilities (Veteran's Affairs, e.g.), creates a gaping disconnect between any level of administrative official, and the individuals actually hospitalized in such facilities. Even human rights advocate John Gallagher (formerly of the Arizona Office of Human Rights) recognized this fact the first time he came to meet with me at ASH, in early summer, 2012, about the issue of Hospital staff who were trafficking in illegal contraband; characterizing in his own words that this disconnect between bureaucratic authority and ASH patient-consumers is precisely why the issue of staff smuggled contraband etc., etc., had been a central problem at ASH for an inordinate amount of years to that date.
Life of a grievance; aka Birth of a death star.
I have extensively written about this issue in the past. Wherein such staff smuggled contraband- namely addictive substances such as tobacco- is the first issue I formerly sought to address through Hospital protocol in itself, and then through the health department's Office of Grievances and Appeals. I took this action on the basis of some of my earliest experiences at ASH (within days of my January 11, 2011, arrival to ASH), and my recognizing that the issue posed grave risk of harm to me and any number of other non-involved patients, on point with the risks associated with such drug selling in any other setting.
Not to necessarily mention to the health risks directly associated with the use of tobacco, which annually kills more Americans then alcohol, auto accidents, illegal drugs, murders and suicides combined.
Or the significance of the issue when present in a freaking hospital, of all places.
With all elements of this issue in mind, I had- as per protocol and the ASH Patient Manual- initially relied on my first attending psychiatrist (Patel) to take some/any nature of action to act in interest of his patient-clientele and rid the Hospital of such staff corruption, but again found him rutted in his highly unethical attitude, "This is the state hospital. What do you expect?".
Not willing let the matter drop (as Patel attempted to get me to: "Worry about your treatment, and not what goes on with other patients..."), I then filed an in-hospital grievance with the on-site patient advocate, again as per protocol, wherein I described my personal experiences in direct relation to the issue (including Patel's bullshit), as well the horrific significance of it all with health in mind. This was my first actual grievance (I ultimately filed eleven such complaints- always in good faith, reasonably diplomatic language, and as per protocol), and I attest to believing this would serve to address this issue in some/any way. But even this person was unwilling and unable to do anything in her own right about the matter. (I learned later, as did the public once ABC Ch15 got involved, that it was impossible for this individual to thoroughly meet her job description because ASH administrators wouldn't let her to!)
Thus compelling me, as per protocol, to appeal the grievance to the above identified health department office of grievances and appeals. And I kid you not that I did at this feel safe in presuming those people would do the right thing. But they in turn refused to even acknowledge my concerns, and the plain fact is, I was not responded to as per the specific standards of Arizona administrative law and associated time line requirements, a pattern that I in time identified as standard practice in context. It was that bad, that early on.
Involved parties to that point of the process included such bureaucrats as former-since fired Cory Nelson and Donna Noriega, senior medical staff such as both Chief Medical Officer Steven Dingle and Laxman Patel, and state health department officials such as Kara Burke, Teresa Bedoni and Margery Ault.
Frustrated, disturbed, and even frightened by the way in which this process was playing out, I chose to write a letter to the Arizona Office of Human Rights, wherein I described all applicable details as they stood then. I went further in stating that, should nobody step forward and in some/any way work to address this issue (!), I would exercise my civic duty by alerting federal authorities in the Office of Alcohol,
Tobacco, Firearms and Explosives (ATF), which in part:
Disrupts and dismantles criminal organizations by identifying and arresting offenders who illegally traffic tobacco products, and conducts financial investigations with ongoing criminal investigations in order to seize and further access to assets and and funds used by involved criminals and and terrorist organizations.
(SEE: www.atf.gov/resource-center/fact-sheet/fact-sheet-tobacco-enforcement)
Approximately two weeks after I put that letter in the mail, John Gallagher appeared seemingly out of the blue. After a basic introduction and the request to speak with me, his first words were (verbatim) "You write very good letters". We then sat down for a good 30 minutes in order to discuss what I would agree to in terms of taking this matter to task. Despite he being as much mired in a bureaucratic system, during that first meeting (we had several over the next four months), I found John to be a very intelligent and seemingly dedicated to meeting his given responsibilities as a state employed servant to the public, and indeed, he stated his interpretation of it all being representative of a graphic disconnect.
Ultimately on that specific date, we decided upon this office sending a "shot across the bow" form of correspondence to both Hospital administration as well as the then director of the state's health department, Will "Yea Team!" Humble.
There's quite a bit more to how this particular issue played out during my thirteen hellish months in Arizona's long term public mental health care facility. (At one point, ASH security closed the outside [on the grounds] patient bathrooms where the bulk of the trafficking went on, a not so brilliant action that immediately led to patients defecating on sidewalks and other such spots... Couldn't make this shit up if I had to...).
But suffice it to say, that by the time I left ASH in February, 2012, it was clear to me that the staff centrally involved in this particularly insidious pattern of lawlessness were well aware of the safety net provided them by the behemoth bureaucracy known of Arizona Department of Health Services. Granting such staff the means to engage in a profiteering scheme that flies in the the face of state and federal law, with no concern for patient health and welfare.
Goddamned bureaucracy. As mentioned above, I properly filed a total of twelve in-house patient grievances during my time at ASH, and not one- not one single such filing- was responded to in support of my concerns, and for the most, part without abiding to the rules of procedure that underlie the already the state's own protocol. It is no mystery to societal and cultural scholarship that systems of bureaucracy bear little resemblance to what can serve the needs of persons vulnerable to systemic negligence and abuse, be they affected by mental illness, old age, economic disparity, and so on.
Going through this, time and time again while hospitalized at ASH, and even later, when I took my final appeals of four of these complaints into the Arizona Office of the Administrative Court, left me with an utter sense of despair in relation to whatever sense of faith in the ADHS system I had when going in.
As the film I, Daniel Blake (2016. Ken Loach, director, Paul Laverty, writer)- which won the Palme d'Or award at the 2016 Cannes Film festival- passionately portrays, bureaucratic systems of public health are so tied up in formwork and incompetent staff, that the humiliation associated with going through such processes is dehumanizing to the nth degree. Which in turn, directly exacerbates the struggles that persons vulnerable to negligence and abuse were dealing with before even seeking remedy through such systems.
Likewise, the abject histories of bureaucratic institutions are so well known that formal studies of these systems are offered in graduate programs in schools as prestigious as Yale in the USA, and Cambridge in the UK. I should know, for I completed course work about this issue in relation to my undergraduate minor in Science, Technology and Society, specific, under the tutelage of Dr. Tim Moy, Phd., Harvard.
Herein, the basic wrongness of having state bureaucracies manage facilities such as ASH is, in fact.
Sadly, persons such as Cara Christ and Greg Honig, and other such members of Arizona's public health care construct very likely have little to no understanding of any aspect of this issue. While, on the flip side, it is possible that such individuals actively seek work in bureaucracies because these factors effectively make their jobs easier. Whatever the case, these people are generally so out of disconnected from the actual client-consumers (individuals) they are obligated to serve, that the negative impacts of it all land squarely on the heads and shoulders of such individuals. It's this plain, it is this wrong.
And it sure as hell doesn't only happen in Arizona.
Enter Montana State Hospital.
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Jay Pottenger
Chief Executive Officer, bureaucrat.
Montana State Hospital,
Warm Springs, MT.
August, 2016-present |
As a matter of offering more evidence to the effect that persons in bureaucratic authority may well have no grasp of what the hell is going on, including in terms of actual responsibility that stands free of the mechanisms of these systems, I will give a brief description of more recent history and my personal experiences as consumer of public health services in the state of Montana.
In sum: Beginning in November, 2016, the Centers for Medicare and Medicaid Services(CMS), a subsidiary agency of the United States Department of Health and Human Services, initiated a formal investigation of the Montana State Hospital, located in Warm Springs, on the basis of information previously shared with them by the staff of PJ Reed The Arizona State Hospital and Patient Abuse.
The results of this critically needed investigation culminated in the identification of over one hundred eleven (111) specific violations of the clearly established law and policy by which MSH is licensed to operate,
all of which were subsequently included in a fifty nine (59) page final CMS report.
As a consequence, in January, 2017, this Hospital was slammed with a federally issued notice of IMMEDIATE JEOPARDY (IJ) by (CMS), putting the facility at risk of being decertified (losing its license to operate). Very much like what went in Arizona circa 2013-14, and the scandal that erupted there in spring, 2015; wherein the CEO of ASH at that time, Donna Noriega (amongst others) was found as duplicitous in furthering a range of activities known to be violations of health care law and policy.
As such, very much like what went on in Arizona, this specific example of yet another state mental hospital's failure to abide by established standards arose in part (arguably large part) to the dismal ignorance of MSH's current Chief Executive Officer, Jay Pottenger, which was presented in pretty square terms by the final CMS report itself:
"This meeting was requested by the (CMS) survey team to ensure that staff member A (Pottenger) had been made aware of this Immediate Jeopardy concern and to clarify any questions staff member A may have had.
Staff member A stated he was not aware of whom the governing body would be, but perhaps thought it might be himself.
Staff member had additional questions on how the governing body functioned as it pertained to the facility."
(United States Department of Health and Human Services. Centers for Medicare and Medicaid Services. OMB No. 0938-0391. January 01, 2017. Montana State Hospital. Provider/Supplier/CLIA Identification Number 274086. Page 15.)
Can you imagine going into a restaurant kitchen and asking an on-shift dishwasher what his title is, what work he's supposed to do, and what are the responsibilities that he is paid to perform? And having the guy respond: "Who's the dishwasher? Me? And while we're on it, what does a dishwasher do, anyway?"
This fat-cat goddamn bureaucrat Pottenger has over 30 years of hospital management experience in bureaucratic systems not limited to state agencies, and astoundingly, ridiculously(!) failed to understand his own freaking job title (!), job description (!), and his associated responsibilities in context when asked by the licensing agency by which he has a freaking job about these basic matters.
Utter buffoonery at the top of MSH' administrative authority, 100% like Cory Nelson-Donna Noriega.... and Bowen? Yet again and in stark form, another bright line example of the potential ignorance of persons accustomed to working in bureaucracies.
Could not make this shit up if I had to.
And, for what it is worth, MSH is still today subject to direct federal sanction because- just like ASH back in 2013-14- they cannot get their shit together.
Just as sad, this ignorance may seem to serve as an excuse for the issues that have arisen at ASH and other like institutions, self-forgiveness that these dumb-asses rely upon in order to justify maintaining their entrusted state employment positions (Pottenger still runs MSH, e.g.).
But I am not about to accept any such excuse, justification, or rationale, be it in Montana, Arizona, or anywhere else. Knowing as I do that, on any given day, these sorts of people leave those hospital grounds and go home to any level of comfortable surroundings, possibly eating in a fine restaurant, seeing a movie (known sexual predator Dr. Steven Dingle, e.g., has long been a board member of the Phoenix Metropolitan Symphony); while the disabled citizens that they are required to serve remain in a setting that few Americans would be capable of tolerating.
And as stated, the above described example of how poorly MSH is managed and what got them in trouble virtually match the same body of violations that arose at ASH in 2013-14. Go figure.
(See: Warm Springs assaults blamed on 'chronic, pervasive staff shortages. Holly Michels. Lee News. March 08, 2017.)
But all of that said, an expression of citizen disagreement about patterns of horrendous mismanagement at state mental hospitals that barely scrapes the surface of what bureaucracies are about in context, this newly revised and amended version of Arizona Senate Bill 1450- bureaucratically fashioned as all get out (not Sentator Barto's fault, it is the nature of state's administrative code in itself)- is still representative of a very much needed alteration to the standards specific to this statute. This in the interest of all ASH patients forensic or not, and not to that of sexual abuser Dr. Steven Dingle, or any other employee of the state itself.
IN CLOSING: Lots of attention being directed to this publication over the the last 3-4 weeks, included hits on articles produced in 2012, when this blog was founded. Never too sure who all may be involved, but at least proportion of it all is coming from ASH administrators and other like Rapscallions in the public state health care construct.
That is how it's always gone.
paoloreed@gmail.com
