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Spokane, Washington  Est. May 19, 1883
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Secrecy only breeds suspicion

The Spokesman-Review

No one should have been startled this week when tension surfaced between Spokane County’s community services director and Spokane Mental Health. After all, there’s been conflict there for at least a decade.

So while it’s understandable that county Community Services Director Kasey Kramer would be stealthy in the way he raised his latest concerns about the nonprofit agency, it’s also troubling.

Kramer doesn’t believe Spokane Mental Health is as cost-effective as it should be in deciding whether mentally ill patients should be committed to Eastern State Hospital or given alternative treatment in the community. He wants to award that work to someone else.

As long ago as 1995, when Spokane Mental Health ran all of the county’s mental health services, Kramer was challenging the efficiency of the agency and the monopoly it enjoyed. At that time, he talked county commissioners into putting the service out to bid, but Spokane Mental Health persuaded them to change their minds again.

Kramer didn’t give up. In 1999, after months of wrangling, county commissioners shifted the responsibility that had been Spokane Mental Health’s for 30 years to a managed-care company, California-based United Behavioral Health. Spokane Mental Health’s supporters protested, predicting that United Behavioral Health’s bottom-line consciousness would diminish services and put patients at risk.

When several rehabilitative programs disappeared, constituents complained loudly.

In 2000, county officials challenged Spokane Mental Health’s account of the adverse economic impact it had suffered. The county also accused the nonprofit of double-billing for its services. Based on a report by county Auditor Vickie Dalton, county commissioners withheld some $200,000 a month in payments.

Seven months later the county had to concede that the billings were legitimate after all and cut a $1.55 million check to Spokane Mental Health.

This year, with that long and awkward history as backdrop, Kramer recommended to county CEO Marshall Farnell that the screening of mental health patients be turned over to United Behavioral Health. He did this in a memo, predicting that if Spokane Mental Health found out what was up, it might try to rally media attention and bring pressure on the county commissioners.

Even county commissioners seemed caught off guard, but they directed Kramer to seek competitive bids before the Spokane Mental Health contract expires in three and a half months.

Indeed, Kramer’s concerns are worthy of close inspection. The county paid the state $1.6 million in fines for sending too many patients to Eastern State Hospital in the 2003-04 period.

There is no valid excuse, however, for the surreptitious way the matter was brought to county commissioners’ attention. The glare of a public spotlight may make public officials uncomfortable, but it is the only way to assure legitimacy and accountability in public policy.

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