Auditor Logo Susan Montee

Report No. 2010-167
December 2010

Complete Audit Report

Findings in the audit of the Department of Mental Health, Office of Director

PACT Initiative
The department did not initially handle a contract to privatize the operation of a 25-bed adult acute care unit and emergency room at the Western Missouri Mental Health Center (WMMHC) in an open, transparent, and competitive manner, and subsequent efforts to do so were not performed timely. The DMH did not initially announce its intent to privatize these acute care and emergency service operations and solicit proposals from interested health care entities in the area. Instead, during the summer of 2008 or prior the DMH entered into discussions with the Truman Medical Center (TMC), a private not-for-profit health care entity in Kansas City, to determine its interest in leasing these operations from the department.

While various meetings were subsequently held between DMH officials and its stakeholders regarding this privatization initiative at the WMMHC, the DMH did not formally solicit proposals or responses of interest from local community hospitals/health care entities until February 2009, only 4 months before the contract became effective. In February 2009, the DMH mailed a Request for Information (RFI) to local community hospitals to solicit formal interest and requested all interested parties submit a response regarding their interest in operating these beds and emergency services. Responses were due 12 days later.

The DMH received only two letters of interest, one from the TMC and negotiations with that entity began shortly thereafter. The other community hospital which responded to the RFI ultimately withdrew from negotiations in March 2009. As a result, the DMH lost any negotiating leverage that may have existed during its initial negotiations with the TMC. Because the decision to end the state's operation of those services had already been made and the DMH had considered the proposed savings in the core cuts to the fiscal year 2010 budget, the department was at a disadvantage during subsequent negotiations with the TMC.

Overtime-Related Issues
Some employees at DMH operating facilities worked excessive amounts of overtime. This situation has occurred because neither the DMH or the applicable operating facilities have established policies limiting the amount of overtime an employee is allowed to work. For example, during calendar years 2008 and 2009, a direct care employee at the Marshall Habilitation Center worked a total of 6,075 hours of overtime (or an average of 253 hours of overtime per month). This employee's overtime pay during these 2 years totaled $98,874, compared to regular salary payments totaling $45,030 during the same period. Employees working excessive amounts of overtime could compromise the health and safety of both clients and themselves by increasing the risk of medical errors, accidents, injuries, poor performance, and other problems.

For the 3 years ended June 30, 2010, the DMH paid employees approximately $47.8 million in overtime department-wide, with most of this overtime being paid at a rate of time and one-half. Neither the DMH central office nor its facilities have performed cost analyses or studies to determine whether hiring additional employees would be more cost effective than paying significant amounts of overtime to existing staff.

State law requires that at the beginning of each year nonexempt direct care state employees are to be paid for any overtime hours earned and accrued from the previous year, though employees have the option of retaining up to 80 hours compensatory time at year end. However, in January 2010, we identified 153 nonexempt direct care employees at the various operating facilities were allowed to retain compensatory time in excess of the 80-hour limit.

Complaint Investigations
Initial investigation inquires were not always completed timely, nor were subsequent investigations always started in a timely manner by the Investigations Unit. In addition, in some cases investigators were granted additional time to complete investigations; however, investigations granted extensions were not always completed within the proposed timeframe.

Monitoring of BRIDGES Program Contract
For over 9 years, the department's Division of Comprehensive Psychiatric Services (CPS), has contracted with a not-for-profit corporation to establish and implement the BRIDGES Program, a program described as a peer-to-peer education and support group program for adults who have a diagnosis of mental illness. The DMH expended in excess of $320,000 during the 3 years ended June 30, 2010, pursuant to this contract. The CPS did not properly monitor this contract to ensure the contract requirements were met or applicable services were actually provided. When asked for documentation related to the contract provisions, a CPS official indicated the required documentation had not been received or requested from the contractor in recent years. The most recent contract documentation of this nature which could be located dated back to 2002.

Payment of Operating Costs of the Governor's Office
Since January 1, 2009, the DMH has been requested to pay costs totaling $50,400 related to the operations of the Governor's Office, thus circumventing the appropriation process established by the General Assembly. These costs represented a portion of the salaries of at least three Governor's Office staff and the costs of some airplane flights.

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