Conflict of interest claims arise from local psych provider’s relationship with state board

Mental health monopoly? 

Local officials and others concerned about the state of mental health care in Mobile, Washington and Baldwin counties are questioning an apparent conflict of interest between the area’s largest provider of psychiatric services and the board tasked with determining where state money for the area is spent.

AltaPointe Health Systems’ gobbling up of smaller providers and its merger with the local 310 boards, which distribute funding, have given it an unfair advantage when it comes to state money for services and, in some cases, the company has helped to prevent other service providers from entering the market. 

District 6 Mobile City Councilman Scott Jones is one of the loudest critics of AltaPointe and its apparent stranglehold on mental health services in the area. Even after a recent official visit to an AltaPointe facility as a member of council, Jones said he has “more questions than answers.” 

Jones became interested in the local mental health system after hearing about the struggles Veterans Recovery Resources (VRR) has had getting a foothold in the market. 

AltaPointe gets the majority of state funding for mental health services in the area and keeps receiving funding from local governments, Jones said. He openly questioned why AltaPointe received more county funding recently — to the tune of $8 million — than VRR, which received $3 million. 

“Why should AltaPointe receive $8 million when they already get the lion’s share of state funding allotted to them?” Jones asked. 

The 310 boards for the area counties determine where the funding from the state department goes and in the case of Mobile, Baldwin and Washington counties, the board is made up of entities AltaPointe has purchased, giving it total control. 

Like others interviewed for this story, Jones doesn’t believe AltaPointe is subjected to proper checks and balances because it is, in essence, the one making decisions about where state funding goes. 

310 BOARDS

 The public boards, put in place after the state stopped its reliance on big psychiatric hospitals, control the funding that comes in from the state department and distributes it to providers in specific areas. Mental health care insiders have questioned how AltaPointe can be held accountable by a public board it controls. 

AltaPointe CEO Tuerk Schlesinger said the local 310 board holds the company accountable for the service it provides to patients, as do the agencies tasked with providing accreditation for mental health facilities. 

“[The boards] also hold us accountable because they’re accountable to the cities and counties that appoint them,” he said. “We’re also joint commission accredited, public health accredited for the hospitals, department of mental health accredited for the mental health center and department of human resources accredited, and these are the things that are overseeing and making sure we have quality and we have accountability both with service delivery and financially.”

When asked if he thought the system would work better if AltaPointe and the board were separated, Schlesinger said that would be inefficient. 

“You want to set up bureaucratic boards that do nothing but have other overhead that needs to be spent on overhead to send down to another company that has overhead,” he said. “I don’t think that’s an efficient way to spend government funds.”

Despite the municipalities’ involvement in the selection process of 310 boards’ members, in most cases across the state, especially in rural areas, one mental health provider controls the board, Dr. Jim Dill, former executive director for the Alabama Council, a lobbying organization for 310 boards, said.

It’s no different now in Mobile, Washington and Baldwin counties, but it used to be, before AltaPointe took over as the community health center. 

Multiple sources described to Lagniappe how Schlesinger and Mobile County Mental Health, which later became AltaPointe, gained control of smaller 310-affiliated agencies, which ultimately gave AltaPointe control of the entire local 310 board. Sources familiar with the process who asked to remain anonymous for fear of retribution, said one of the carrots dangled to entice these entities to merge with AltaPointe was inclusion in the Retirement Systems of Alabama (RSA).

Schlesinger vehemently denies the accusations, saying the only mergers that occurred happened because the other entities were closing and they asked AltaPointe to take over. 

“First and foremost, we did not ask anyone to merge with us,” he said. “Those entities were small and struggling and asked to join us.”

Schlesinger added that new employees are not eligible for RSA retirement benefits, as AltaPointe’s participation in the system has been phased out. However, RSA Deputy Director of Administration Jo Moore said both new and current employees at AltaPointe are still eligible for enrollment. 

While questions remain over how Schlesinger and AltaPointe convinced leaders of other 310 entities into mergers that helped the company consolidate power, there is no question the mental health provider successfully took control of the local 310 board several years ago. 

Schlesinger approached the Mobile County Commission at one time to merge AltaPointe and the 310 board for Washington and Mobile counties together. To allow the move, the commission required Schlesinger to seek approval from the other entities involved. Former U.S. Rep. Bradley Byrne, who served as an attorney for the Drug Education Council at the time recalled helping the Drug Education Council legally maneuver the merger to carve out drug-related services for them. 

In 2014, Schlesinger approached the Mobile County Commission again to ask to merge with Baldwin County. At the time, Schlesinger told Lagniappe the move would be good for both boards, as it would increase resources for mental health services through economies of scale. 

AltaPointe has also merged with the state mental health center in Talladega County. A source called that merger “unprecedented” as it was the first time a county’s 310 board merged with one that wasn’t contiguous. In a follow-up interview, Schlesinger confirmed it has happened again with another community health center since that time. 

Executive directors of two 310 board-related entities competing for grants against AltaPointe said the sheer size of the company makes it nearly impossible to grab a foothold. 

In another example of this, VRR had to go around AltaPointe for a federal grant after Schlesinger refused to write a letter stating his company provided a certain service in the county that would’ve helped VRR get the grant.

Emails obtained by Lagniappe show VRR has been denied entry into the 310 board lobbying group called the Alabama Council without any explanation and despite VRR being a member of the National Council. 

Of VRR, Schlesinger said he was fully supportive of what it is doing. 

State Commissioner of Mental Health Kim Boswell defended the optics of state community health centers like AltaPointe merging with 310 boards and creating what many see as a conflict of interest. She called the issue “unique to Mobile,” but said she didn’t have a problem with it. 

“I totally understand how if someone is trying to get into that market it might be an issue for them, but AltaPointe has every piece of the continuum of care,” Boswell said. “AltaPointe is our only community health center that operates hospitals and so everyone else in Mobile decided to get out of the psych hospital business.” 

Strategic Behavioral Health

In 2014, commercial real estate agent Pete Riehm worked with the development director of a mental health hospital called Strategic Behavioral Health in its attempt to put a 72-bed psychiatric facility in Mobile. The group had chosen a piece of land and was set to bring the hospital to the city, Riehm said. Only one hurdle remained — getting approval from the state’s Certificate of Need (CON) Board. Schlesinger was a member of the board at the time, but recused himself from the vote. 

Mobile Mayor Sandy Stimpson, Mobile County Sheriff Sam Cochran and others wrote letters of recommendation to the CON Board, Riehm said, but the officials still voted it down. Sources have said Schlesinger contacted at least some of those involved in writing letters of support after the fact. 

“We had made our case,” Riehm said. “Everyone agrees that we need it, but it was denied.” 

Not only was the hospital unanimously denied, but the board also put an 18-month moratorium on bringing hospitals in, Riehm said. 

“There was no discussion,” he said. “The meeting just adjourned. They got up and walked out.”

Riehm admits he has an ax to grind, but still thinks the board’s decision to stop the new psychiatric hospital was a “travesty.” 

“It was a crime against the citizens of Mobile,” he said. “There are all those people who need services.” 

In an interview with Lagniappe, Schlesinger said the hospital in question would’ve only taken paying customers and left AltaPointe with patients who had no insurance and couldn’t pay for services. 

“The other hospitals in the area spoke against the other hospital,” Schlesinger said. “The commissioner of mental health spoke against them. Why would they do that if they’re for the proliferation of mental health services? They did it because they knew they were bad for this community.” 

As it stands, Schlesinger said, only 21 percent of AltaPointe’s EastPointe hospital patients have insurance. The number of uninsured or “indigent” patients in Baldwin County through involuntary commitments is “killing us,” Schlesinger said. 

“We went into this business as a provider of last resort,” he said. “We actually know that without that 21 percent our hospital couldn’t take care of the other 79 percent of the patients who have no insurance.” 

Riehm accused Schlesinger and AltaPointe of turning away indigent patients, especially those who are involuntarily committed through Mobile County Probate Court. He added that with effective control of the counties’ 310 boards, AltaPointe directs where the funding goes while benefiting from that funding, which would be a conflict of interest. 

“They have an absolute monopoly,” Riehm said. 

Need

The issue of a perceived monopoly is distressing to local leaders and many who work in the mental health field because the need for more services is apparent. 

John Kilpatrick, founder and executive director of VRR, said he opened the facility initially as a residential detox center for veterans, first responders and their families because there wasn’t one in the area. The closest such facility was Bradford in Birmingham. Bradford fought VRR in its hearing in front of the CON Board, but VRR prevailed. 

Also, Kilpatrick said, veterans were waiting six to eight months for services at the Veterans Affairs (VA) hospital in Biloxi. Now, he said, wait times have shrunk a bit. 

“I would meet with veterans and try to help them, but they’d have nowhere to go,” Kilpatrick said. “I decided we’d build our facility to add capacity, but then I realized accountability was the problem.” 

VRR is now a fully certified, full-service clinic, offering not only mental health services and substance abuse help, but also offering primary care. 

Veterans and first responders won’t just go anywhere to receive services like those provided by VRR, Kilpatrick said; a clinic has to build trust. One way to build trust, he said, is to provide culturally competent care, which VRR does. Culturally competent care means VRR hires active and retired military personnel and first responders who can earn trust quicker than a civilian medical professional can, Kilpatrick said. Only 17 percent of mental health providers offer culturally competent care and VRR is one of them, he said. 

“If you’re seeing a mental health provider, they have to know what you’ve gone through,” Kilpatrick said. 

Like Kilpatrick, everyone Lagniappe interviewed spoke about the need for better mental health services, including Mental Health Commissioner Kim Boswell. Boswell called it the top public health issue facing the state. 

“From my lens and perspective, mental health is the most challenging health-related issue we have going on in our community,” Boswell said. “You can’t separate the body from the head and so as your mental health goes, so goes your physical health. So, it really is a pretty critical issue for people in our state.” 

While Boswell acknowledged the need, she said Gov. Kay Ivey and the State Legislature have been “very, very generous” with funding. 

“So, we are extremely grateful for the commitment from the governor and a very dedicated group of legislators, who really understand the mental health issue, who listen to their constituents and their police chiefs and their sheriffs talk about what they are seeing in their community,” Boswell said. “So, we’re very grateful for the resources that have been made available to us over the last three years.” 

Behind bars

Mental health issues at Mobile Metro Jail are a big problem and not enough is currently being done about it, Sheriff Cochran said. 

“We’re the persons of last resort and unfortunately, ‘last resort’ is not very far down the list,” Cochran said. “When people call us they’ve only ticked off one or two things and then they get to us. We have to intervene and unfortunately, the way we have to intervene to get somebody to help them is to arrest them and, of course, in the real bad cases we’ll arrest them, put them in jail and we’ll file a petition to have them committed.” 

One day earlier this year, Cochran said, of the 1,300 or so inmates at the jail, some 330 were on mental health medication — nearly a quarter of the jail population. Some of those inmates, Cochran said, are only in the jail due to mental illness, and it’s not the proper place for them. 

“We’ve had some really bad, bad cases where the [district attorney’s] office will say we can’t go to trial on this because we can’t convict him because he’s mentally incapacitated,” Cochran said. “That’s the problem we face in the state of Alabama when they shut down Searcy and only left one institution. They have limited beds so when you have somebody down here who needs it there’s a waiting list.” 

Despite petitioning severe cases to be involuntarily committed to an AltaPointe facility, for which the company receives public funding, Cochran’s office contracts for mental health services as well. An issue for Cochran is the length of time AltaPointe can hold an involuntary commitment. 

“They go to AltaPointe and spend five to seven days there,” Cochran said. “They put them on drugs, get them regulated and then they release them back out into the community.” 

Many times when a committed inmate is released, they’ll stop taking medication and end up right back in jail. These inmates, Cochran said, are referred to as “frequent flyers.” 

While Cochran said longer holds at AltaPointe for inmates with severe mental illness could help, he acknowledged that the state’s community health center for the local area would argue they’re full as well. 

Schlesinger said AltaPointe is legally limited on how long they can hold an involuntary commitment. 

“People who have mental health problems can stabilize, and once a person is stable and is no longer a risk to themselves or others, we can no longer hold them involuntarily,” he said. “That’s the law. For somebody who is mentally ill and is stabilized, even if they are a past offender and at the time were a risk to themselves or others, but they aren’t anymore, it’s a violation of their rights to hold them against their will. We can’t warehouse people because at one time they were showing symptoms of mental illness.” 

Aside from the involuntary commitments, Schlesinger said, AltaPointe has several initiatives designed to help both patients and non-patients avoid jail. He said the company participates in a stepping-up program that screens people coming into the jail, looking for AltaPointe patients. 

“If they are an AltaPointe patient, we work with the jail’s health care to make sure they stay stable,” Schlesinger said. “We help get them to the bond hearings and get them discharged as quickly as possible.” 

AltaPointe also has a jail diversion program, Schlesinger said, that follows patients released from jail for up to six months to make sure they don’t go back in. 

“We have seven to 10 inmates admitted to our hospital every week to make sure we help stabilize anyone who is at risk of hurting themselves or someone else,” he said. “We are as concerned about the jail as the sheriff is. That’s why we’re working so much to put in as many jail diversion treatment programs in place as we can to reduce recidivism of offenders.”