Mental-patient-turned-accused-killer slipped through state’s fingers

February 1, 2009 by  

Laurie Roberts (AZ Republic Columnist) among others report on the latest high profile cases involving behavioral health patients.  Legislation (HB 2205) I sponsored forming a task force to look at the state’s system of funding behavioral health in Arizona will be considered again this session. 

In August, a Maricopa County Superior Court judge ordered that Joe Gallegos submit to psychiatric treatment.

Four months later, two boys lay dying on a southwest Phoenix playground and Gallegos – the man that Magellan Health Services had been ordered to watch – was arrested for murder.

Now state records show that a patient believed to be Gallegos was never given a psychiatric assessment by the clinic assigned to treat him, had no documented treatment plan and didn’t meet monthly, as required, with his case manager and his doctor.

 “The Clinical Director further reported client #1 was never at the facility for an appointment and that no staff member at the licensed facility was able to contact client #1 after being released from the hospital on Aug. 12, 2008, or Oct. 14, 2008,” said a Department of Health Services report released this week.

Translation: Gallegos slipped right through Magellan’s fingers despite a court order that he be monitored. Despite the fact that we’re paying the for-profit company $680 million this year to care for the seriously mentally ill in Maricopa County.

Magellan’s chief spokeswoman wouldn’t comment last week, citing patient confidentiality. On Tuesday, the company didn’t return a call.

While mum’s the word over at Magellan, DHS has launched an investigation and key lawmakers are, to put it mildly, not amused.

 “This is not going to be swept under the rug,” Sen. Carolyn Allen, chairwoman of the Senate Healthcare and Medical Liability Reform Committee, told me Tuesday. “It’s not.”

Allen is planning public hearings next month to get answers — not only about what the heck this guy was doing walking the streets with no oversight but also what the heck we’re getting for our $680 million.

 “Are the people getting the money that need it and the treatment, or is this going into the pockets of the people who are living off of this lawsuit,” she asked, referring to a 25-year-old court case that mandates state care for the mentally ill.

 Meanwhile, her counterpart in the House, Health and Human Services Chairwoman Nancy Barto, plans to introduce a bill calling for a study of the state’s behavioral health system. “There are a lot of questions that need to be asked,” she said.

She’s not kidding.

Here’s what we know thus far about this particular tragedy. Phoenix police were twice called in July – once because Gallegos reportedly called to say that he’d killed his two sons and once because a relative reported that he was off his meds and punching holes in the walls. Each time officers summoned one of Magellan’s crisis intervention teams. On July 31, a petition for court-ordered treatment was filed and on Aug. 12, a judge ordered that he undergo treatment for a year.

Three days after the boys’ Dec. 26 deaths, DHS dispatched inspectors to the Maricopa Clinic-West Camelback to find out what went wrong. They found so many problems that they launched a full-blown investigation the next day. Magellan has since agreed to make “immediate attempts” to contact all court-ordered clients who haven’t been seen in 25 days, DHS says.

According to the DHS report released Monday, a client, believed to be Gallegos, was assigned to the clinic for court-ordered treatment on Aug. 12. Clinic staffers didn’t do a psychiatric assessment because he’d previously received services elsewhere. Instead, they requested the documentation from the other provider but it never arrived.

The report also says there was no initial treatment plan in Gallegos’ file and that he didn’t receive even the minimum monthly visits with his case manager and behavioral health medical practitioner, as required by the court order. He was never again seen after being released from the hospital a second time, on Oct. 14.

The clinic’s progress notes indicate that Gallegos was a no show at appointments and that the case manager couldn’t reach him by phone or by visiting his house. The last time the clinic apparently tried to find him was some time around Oct. 24, when a note in the file says the case manager knocked on his door but got no answer.

That note was written on Dec. 26, by the way — the day the two boys died.

(Column published Jan. 14, 2009, The Arizona Republic)

In other news:  State mental health contract on fire

Magellan Health Services is in the midst of at least three separate state investigations, and that’s the least of its problems.

There’s a growing chorus of advocates, providers and longtime administrators pressuring state health officials to terminate Magellan’s state contract, while lawmakers take aim at the Connecticut-based for-profit company.

A review of court-ordered mental health patients in Maricopa County shows that, in just one clinic, eight patients were never seen by their case manager after the judge’s order and others went for months without a face-to-face visit.

Even when they were deemed a danger to themselves or others, people were left to drift, missing appointments, winding up in jail and, in one case, accused of killing two young cousins in a Phoenix park.

State Department of Health Services officials demanded the review from Magellan, which manages behavioral health care in Maricopa County, days after the boys’ Dec. 26 deaths.

In separate state licensing investigations over the past month, surveyors cited Magellan for dozens of violations at the West Camelback Clinic, where the boys’ accused killer is believed to have been a patient, and at the county’s psychiatric crisis center.

“We’re working with Magellan on a broader analysis of all the clinics,” Dr. Laura Nelson, acting DHS director for behavioral health services, said last week. “How do we know this clinic is different than others?”

The investigations come on the heels of a court-ordered audit that showed most of the county’s 19,000 seriously mentally ill lack adequate case management, appropriate clinical care or follow-up treatment.

Magellan did not return a call seeking comment. But in a Jan. 9 letter to Nelson, CEO Richard Clarke outlined the steps the company would take to focus on the roughly 1,500 people facing court-ordered treatment in the county.

That includes reassigning staff, including medical director Chris Carson, and bringing in officials from Magellan’s national office to review operations in the system’s 24 clinics.

Magellen likely faces fines for the licensing violations and already has been fined several times in recent months for failing to live up to the terms of its $1.5 billion three-year contract.

That may not be enough.

Pressure is mounting on the state Department of Health Services, which oversees Magellan, to get rid of the for-profit contractor and have the state run the system itself.

A joint House-Senate hearing into the Arnold vs. Sarn lawsuit, which governs care for the seriously mentally ill in Maricopa County, set for this Wednesday has been canceled by Senate President Bob Burns so lawmakers can focus on getting a $1.6 billion budget-balancing plan to Gov. Jan Brewer’s desk by this weekend.

But behind the scenes, behavioral health experts are working on a plan to reinvent the entire system statewide and perhaps do away with regional behavioral health authorities, like Magellan.

In the meantime, a hearing before Maricopa County Superior Court Judge Karen O’Connor to review the audit findings and discuss how to proceed is expected in the next few weeks.

Attorneys representing the mentally ill have declared the system broken and are urging state officials to terminate Magellan’s contract, which began in September 2007.

In Magellan’s own review of court-ordered patients receiving treatment at the West Camelback Clinic, eight of the 102 patients were never seen by a doctor, case manager or anyone in the system after a judge ordered them into treatment.

Others repeatedly missed appointments and then turned up in the county’s urgent psychiatric center, or a hospital emergency room, or the county jail, according to a spreadsheet released by DHS.

Four of the eight who were never seen had the same case manager, Frank Ramirez, and six had the same clinical coordinator, Curtis Shane.

In the case of Joe Sauceda Gallegos, who’s been charged with the beating deaths of the two boys in a south Phoenix park, records show he got virtually no supervision, no treatment plan and no assessment for his mental health problems. That’s despite being ordered into in-patient evaluation and treatment Aug. 12 by Superior Court Judge Patricia Arnold.

The state licensing survey of the West Camelback Clinic, conducted Dec. 29-31, shows that, “Client 1,” believed to be Gallegos, showed up in the Magellan-run Urgent Psychiatric Center Oct. 6, was seen by a Magellan case manager there Oct. 10, and was to have been discharged Oct. 14.

He then missed appointments on Oct. 17 and Oct. 23, according to state records. A case manager went to Gallegos’ home Oct. 24, but no one was home, according to the survey notes. There’s no record of any further attempts to contact him.

On Dec. 23, cousins Edwin Anthony Pellecier Jr., 10, and his cousin Jesse Michael Casillas Ramirez Jr., 7, were beaten to death at a southwest Phoenix park. Police said Gallegos, 36, was seem on a surveillance camera following the boys and carrying a long object.

Phoenix police arrested Gallegos hours later at his home nearby. They found a baseball bat and what appeared to be bloodstained clothes and blood on his shoes.

Both boys died from their injuries Dec. 26.

Among the 26 state licensing violations that investigators found at the West Camelback Clinic, case notes in Gallegos’ file were documented Dec. 26, though they pertained to activities that purportedly took place in October, such as the visit to Gallegos’ home.

Regulators last week cited the UPC, where Gallegos was held, with 15 violations, including holding people for up to four days in what’s supposed to be a 24-hour stabilization unit.

“This was never intended to be a unit where you keep people longer than 24 hours. And they had in-patient beds,” said Alan Oppenheim, deputy assistant director for licensing at DHS. “If they need more care, they should move on to an in-patient bed. They should be moving on to get better levels of care.”

In fact, all of the people who stayed longer than 24 hours in the observation unit were ultimately admitted. And there was no bed shortage at the time, according to the state investigators.

“That’s not a good thing to do to people, to leave them in that limbo,” said Nancy Diggs, appointed by the court to monitor compliance with the lawsuit.

“Prior to Magellan coming in, there was a fairly elaborate process that kept track of all individuals that had been court-ordered for treatment,” Diggs said. “During the transition, that apparently went away.”

Another investigation of the UPC was launched in November after Diggs notified health officials that she’d received several calls from current and former employees about conditions there.

Those complaints, primarily related to patient mistreatment, were unsubstantiated.

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