The place eerily resembles the former high school it once was, although it is obvious someone attempted to give it a less institutionalized feeling.
The top half of the hallways are painted a warm beige and the bottom half a muted mauve. Inspirational, colorful posters are hung and spaced horizontally about a foot apart. In the patients' waiting room, on the second floor at the top of a grand staircase, a quilt hangs on the wall and mismatched sofas and cushiony chairs offer places to sit.
But a large glass window keeps distance between the receptionists and those who wait.
To get to their counselors, patients wind through cavernous hallways and rooms, traveling on matted, gray speckled carpeting and under high-strung fluorescent lighting.
Geoff Winfree, Umatilla County's mental health service program manager, led the way through the maze recently, pointing out that change was underway. In each of the tiny offices, packing boxes spilled over, chairs were missing and desks were in a more disorganized state than usual.
People were moving and centralizing the offices of their departments, Winfree said, in response to decertification notices sent by the state and the county's mental health care provider. The notices said the quality of the services the county's staff provided for the mentally-ill was so poor it presented a great liability.
"We hope the closer proximity (to each other) makes it easier to communicate and coordinate care," Winfree said.
It's an optimistic viewpoint. The county's health care provider, Greater Oregon Behavioral Health Inc. (GOBHI), has already decertified the program, and is searching for a new provider to take over the services. The state's decertification will expire soon. In fact, the county's mental health program could be out of business as early as Sept. 19.
The county commissioners formally appealed GOBHI's decertification this week and intend to do the same for the state's decertification. They have proposed a major restructuring of the system, hoping to ensure that the services remain under the county umbrella. In addition, they've hired a medical director, Dr. Russell Ferstandig, from Hoboken, N.J., on a month-to-month basis to begin the restructuring. He arrives Sunday.
The county's tenacity seemed to baffle GOBHI's executive committee, who met late last week to discuss the Umatilla County program and hear the commissioners proposal for change.
"I'm so perplexed about you folks wanting to hang onto the mental health program," said Denise Dion, medical director for GOBHI. "It's a downsizing. I would think you would be delighted."
But the county's staff for its crisis services and mental health services, the two departments that could soon be dismantled, want desperately to prove themselves. Many of them are recent new hires, a different team than has been in place since August 2002 - when the county first came under GOBHI's and the state's microscope. They all believe they have been making significant progress in the past year toward improving their level of care for their clients, and many feel that they have been unfairly targeted by GOBHI and the state.
"For every concern, there are dozens of successes," said Charlie Carnes. "We've put too much work into the program for me to feel comfortable walking away from it and having someone else pick up the pieces."
"This isn't just about preserving a bunch of jobs and a structure for employment," he added. "It's got to do with the community and the people we've connected with."
A death sentence challenged
Umatilla County is the only county in the state to get decertified by GOBHI, the state's dominant health care provider. GOBHI spends about $2 million each year on the county's services to its clients, who get the funding help through Medicaid, Medicare and other state insurance assistance.
Yet, according to Kevin Campbell, chief executive officer of GOBHI, the county is serving only about 250 of the 6,500 GOBHI clients living in the county. And he said he doesn't believe the 250 represent the most at-risk mentally-ill.
As a result, the county has been under intense scrutiny by GOBHI for two years. Last year, the services had deteriorated to such a point that GOBHI did not recertify the program, Campbell said. Instead, it offered the county a series of 90 day probationary certifications to continue operating. In the meantime, it assigned three of its agents to work with the county on making improvements. A letter they sent the county commissioners in November indicated that the program was moving in the right direction.
Then came the site review last spring, which became the basis for UCMH's 30-day death sentence, set to expire soon.
In that review, GOBHI and state professionals cited poor record keeping of medical records and lack of timely access to medication management services for consumers. In addition, the report said crisis services are not meeting the health and safety needs of the community, a repeat finding from earlier reviews.
The program's lack of a medical director also raised heightened concerns, Campbell said.
"Although the county was very cooperative and we got to a point where we thought we had a good working relationship, there were still a significant number of issues that remained unaddressed," Campbell said. "The lack of a medical director has been a huge issue."
However, the review, published in August, has been challenged by the county's staff, many of whom have been only recently hired on to the staff. The incidents used as examples of negligence were distorted and from several years ago, they said.
"The actual crisis calls and subsequent interventions by those of us in the crisis intervention services did not even resemble what was written," said Debra Rood, a crisis counselor. "In fact, a portion of one crisis call was sandwiched with a portion of another crisis call. In another case, the incident occurred nearly eight years ago before most of us were even working in mental health."
The thoughts expressed by law enforcement officers on the mental health program were also distorted, said Umatilla County Undersheriff Shane Hagey. Hagey was interviewed by the state and GOBHI, along with others in public safety, and he said the report was far more negative than he remembered officers being.
"I read the report and thought, 'wow,' that was not the meeting I was at," Hagey said. "In the past there have been some problems (with mental health). But I can say that over the last year or so things have improved a lot between crisis workers and law enforcement officers. I think they're working really hard to amend the problems."
Hagey said he called GOBHI and the state and expressed his concern about the way the report read.
"I didn't feel it was fair to the mental health program," Hagey said.
County wants a reprieve
The county has faced challenges in managing its mental health and crisis services, admits Connie Caplinger, executive assistant to the board of county commissioners. One being that, up until now, it has been unable to recruit and retain a medical director to be in charge of the program. In the past several years, it has gone through three of them, spending months at a time in the interim without one.
But on Thursday, the county hired Dr. Ferstandig from New Jersey. He will arrive Sunday and remain on a month-to-month contract which pays him $13,000 for each month. The county will also pay his plane ticket, his room and board, and provide him with a car and cell phone to use while he is here.
His employment is temporary until the county sees how its appeals to both GOBHI and the state work out. GOBHI executive committee members are taking several days to review the county's proposal to restructure its program with a medical board of directors. They could still decide to transfer the county's services in two weeks, allowing mental health services from Malheur and Union Counties to provide them. The county is still in the process of appealing to the state.
In the meantime, Ferstandig's office has been cleared out, and his department heads will have offices nearby - within shouting distance, said Winfree, Umatilla County's mental health service program manager.
Ferstandig, who won't yet have his Oregon license to practice medicine, will begin work on restructuring of the program, and also on building a better relationship with the state and GOBHI.
"I'll give it my best shot," Ferstandig said, by phone Friday. "I don't know the players, and I don't know what I'm up against. It may be more than I can conquer."
Yet he is optimistic about the staff he'll inherit, despite the harsh allegations they've faced lately by local health care professionals who have been challenging the quality of their work.
"They struck me as a really good group of professional people who really want to do the right thing," Ferstandig said. "But they've been compromised because they haven't had a medical director. It's been a really difficult scenario for them."
Yet, he said he has no illusions about what he is walking into. He said he believes he can help the county overhaul its program to meet the standards of the state and GOBHI, and that his unfamiliarity with the local political issues will be a plus to his job.
"I plan to come at this with real abandon," Ferstandig said. "I'm going to be asking a lot of really hard questions of both sides."