State pulls plug
on treatment centerHealth officials close PDMI Care
despite its attempts to address
administrative failings
The state Health Department has closed PDMI Care, a treatment program for acute physically disabled and mentally ill patients, after the state Office of Health Quality Assurance determined it was providing treatment without a license.
The agency told PDMI in October "to cease and desist services that require licensure," said Dianne Okumura, office chief.
Mental health professionals said they are distressed about the program's closure because it was highly successful in caring for some of the community's most severe patients.
"It's astounding what they have done," said Bud Bowles, United Self-Help executive director, pointing out that PDMI Care took people who otherwise would have been in Hawaii State Hospital.
Sharon Fountain, PDMI Care executive director, said the organization didn't believe licensing was required because most clients lived independently in its three Makaha houses and an apartment building it owns in the university area. Case workers provided support services at least 16 hours a day but did no cooking for the clients, she said.
She said the Health Department gave PDMI Care 10 days to produce a plan to correct deficiencies, such as preparing assessments and care plans linked to the program's services to clients.
"We did all of that and they ... failed us again (on Oct. 27)."
Dr. Tom Hester, Adult Mental Health Division chief, reviewed an appeal by PDMI Care and told Fountain Nov. 21 that all issues had been addressed but one, and the organization could apply for another contract. The only remaining issue concerned appropriate insurance, which has been remedied, Fountain said.
Hester said the Adult Mental Health Division values PDMI Care's services "and the spirit in which they were provided." But they "didn't fit into a clearly defined type of service" to meet requirements for Medicaid or other funding reimbursements, he said.
He said the Health Department is discontinuing that kind of service, which was entirely state funded. Instead, it is supporting mental health services that will qualify for federal funding to complement state funding, he said.
PDMI Care's new contract, expected to take effect Monday, is to form a group of professionals -- called an Assertive Community Treatment team -- to provide mental health services to patients placed in the community.
The goal is to maintain the organization's strengths while meeting standards for federal funding, Hester said.
Meanwhile, Fountain is concerned about PDMI Care's former clients, 37 of whom were transferred to other facilities during the appeals process.
Case workers report 10 have deteriorated physically and mentally since the move and another one is missing, she said.
"It's winning the war and losing the battle. Our clients have suffered. Most of our clients call on a daily basis, 'When can I come home?'"
Kathleen Delahanty, Hawaii Disability Rights Center executive director, said it is investigating because some PDMI clients were scattered by the Adult Mental Health Division without adequate discussion or transition planning.
For example, she said two were referred to the Institute for Human Services, a homeless shelter, and one disappeared. Two also were sent to a substance-abuse facility, although they had no substance-abuse problems, she said.
Hester said PDMI's contract, which ended in October, was extended 21 days to assure a transition process by the division and PDMI to provide the most appropriate placement for each person.
He said he knows of only one person sent to IHS, which occurred after eviction from a care home. This was unacceptable and another arrangement was made the next day, he said, adding that the division is investigating the incident.
He said some clients may have been placed with a substance-abuse provider contracted by the state to provide 24-hour housing unrelated to substance abuse.
PDMI Care was founded by longtime psychiatric social worker David Berggren, Fountain's husband, who died of cancer Nov. 30 at age 67."He was very unorthodox in the way he provided care to clients," Fountain acknowledged. "He always put clients before anything else, which is what got us in trouble.
"We didn't have documentation but truly worked on treatment. Our people have been through hospitals. What they need is recovery, a place, a community, where they feel part of, where they can function as contributing members of society."
Psychiatrist Tom Leland, medical director of Community Care Services, said Berggren "was a real leader, inspirational ... because this was one of the programs moving ahead of the pack when it came to consumer empowerment. When it came to recovery, it would have been a model."
Delahanty said she worked with PDMI on patients it took from Hawaii State Hospital.
"The success ratio of them existing in the community was very, very small, and PDMI has had some of these people for years and managed to keep them functioning in the community."
Gary Lowell, PDMI clinical director formerly with the Health Department, said the organization "was able to achieve outcomes no other program had been able to come close to. It really had the concept of understanding what it takes for people to recover in the community as opposed to treatment."
Dr. Denis Mee-Lee, Hawaii Clinical Research Center director and former state mental health director, said PDMI's strength was its flexibility to handle people requiring unique services. It was "a different, special kind of a program."
