What’s missing from all the screaming about Mary Mayhew, the commissioner of the Maine Department of Health and Human Services? Context.
Not that the screaming is wrong or unjustified. The latest about DHHS missing a deadline to appeal the federal government’s decision to decertify Riverview Psychiatric Center is just another headline in a long list of bad press. There’s the mentally ill client who had to resort to legal action to gain access to court-ordered treatment at Riverview, the CDC paper shredding scandal, the bogus Alexander report and too many others to identify them all.
But that type of blunder list goes back far before Mayhew, and that should teach us something.
It should teach us that DHHS needs to be something more than one of those pirate ship amusement park rides swinging back and forth between gubernatorial elections. At the election apex, motion stops momentarily, and the victor declares clarity of purpose in how he will solve the DHHS problem.
Then the downward motions starts. G-force hits, things get blurry, and riders start screaming. Supporters scream about how the current administration is doing a great job with DHHS, and opponents scream the opposite until the next apex, the next moment of clarity. Then it all starts again.
What the screamers need to realize is we are on a ride going nowhere except back and forth. And it’s been going nowhere but back and forth for years.
Take the consent decree that resulted from the state being sued on behalf of patients at AMHI and the mentally ill of Maine. The lawsuit was prompted by the deaths of 10 residents in 1989. The deaths were attributed to “overcrowding, shortcomings in the community health system, and poor conditions in the facility.” That consent decree still stands 25 years later — 25 years of swinging back and forth.
The terms of compliance have been reviewed regularly in court and in reports to the court master, retired Chief Justice Dan Wathen, but the level of compliance necessary for the court to release the state from the decree has yet to be achieved — after 25 years.
Gov. John McKernan was in office when the state got sued. Rollin Ives was the commissioner of then-DHS, and Robert Glover was commissioner of the Department of Mental Health and Mental Retardation, the two departments responsible for AMHI at the time. Both departments were listed as defendants in the case and existed as separate entities with separate commissioners until they were merged into DHHS in the mid-2000s under the Baldacci administration and Commissioner Jack Nicholas.
Prior to that merger, there were other tweaks to the system. Substance Abuse Services was merged with Mental Health and Mental Retardation, and the resulting Department of Mental Health and Retardation Substance Abuse Service eventually became Behavioral and Developmental Service. All in all, the two departments, now one department, have seen a total of 16 commissioners, four governors, two mergers and two name changes in 25 years.
Four governors — Republicans, a Democrat and an independent — have brought in four times their number in commissioners, and many budget and management blunders. It would be nice to isolate LePage and Mayhew as particularly incompetent stewards of DHHS, but doing so, again, reflects a lack of context. Mayhew inherited problems from her predecessor Brenda Harvey, who had costly problems of her own. And it goes on down the line.
Take Kevin Concannon, recruited by Gov. Angus King to head DHS. He came in riding a wave of accolades and left just before a tsunami of bad press hit the department. His negative press involves every aspect of management — from the cruel death of foster child Logan Marr while in the care of a former DHS worker, to missing millions and a $150 million shortfall. Another highlight from Concannon’s tenure was trying to eliminate Medicaid coverage for methadone treatment in 1996. Sound familiar?
In case you are wondering how far a bureaucrat can get on that kind of a performance, the answer is Washington D.C. Concannon now serves as an under secretary in the Agriculture Department in charge of the SNAP program.
Having worked in the field and having had many conversations with professionals higher up the chain than I was, I know attempting to quantify total losses or unjustifiable expenditures in the department during any given administration is silly for many reasons. These reasons include, but are not limited to the structure of the department itself, the variety of ways expenditures happen, the intermingling of DHHS funds in other departments like corrections and education, the caliber and quantity of information made available to the media and elected officials, and the sheer size and scope of a budget overseen by one commissioner who is also responsible for operations.
And then there are costs incurred inadvertently in the name of well-intended progress that are also difficult to measure. Like when restrictions on pain medications supported by the LePage administration were linked to the sudden surge in heroin abuse in Maine.
Or when Concannon created the Physician Directed Drug Initiative and Prior Authorization.
Concannon intended to save the state money by lowering prescription drug costs, an understandable intent. To achieve this he leveraged the Medicaid population to incentivize companies into offering discounted rates to that population. He bragged about needing to get pharmaceutical companies to understand that they “could make even more money by selling more of their product, they just don’t get to make as much per sale.”
The program included a waiver from the federal government to increase access to prescription drug coverage through Medicaid — that’s the “selling more of their product part” — subsidized by the savings. Bringing more medications to more people at a cheaper price must have seemed like a good idea at the time. That is, until 10 years later when MaineCare prescriptions were linked to the prescription pill epidemic.
Which isn’t to say actions like these are singularly responsible for the addiction epidemic. But they are examples of the need for a different leadership structure for DHHS — a leadership structure that fosters a broader vision and better communication. It’s a problem that these actions reflected a lack of information that was readily available — information that could have anticipated areas of concern.
I was teaching teenagers in the late 1990s/early 2000s, and I was painfully aware of the prescription drug diversion trend from my students’ stories, even back then. The diversion stories weren’t limited to painkillers; benzodiazepines like Klonopin and ADHD drugs like Concerta were also hot commodities. And I couldn’t have been the only professional working in arenas linked to MaineCare funds that saw the epidemic in its early stages.
But it took 10 years of a problem proliferating to epidemic status for that information to trickle up the ladder to DHHS leadership and elected officials.
So as we all scream toward the next gubernatorial election, still three years away, we may want to change what we are screaming. It’s okay to demand Mayhew’s resignation, except history suggests a new commissioner won’t be easy to find, nor is it likely that a new commissioner will be able to transform DHHS into anything but a nauseating amusement park ride.
It may be time to rethink the department and its management structure. Expecting one person to oversee the diverse spectrum of functions under the DHHS umbrella and a $3-4 billion dollar budget for a salary of $127,000 is to expect the impossible. Given current circumstances and past history, the first indication that someone isn’t qualified to run the department is a willingness to do it at all.