(April 21) An Orange County-based psychiatrist who has realized a substantial profit over the last four years and nine months on a no-bid contract for the provision of so-called mental competency restoration services was this week given another one-year, no-bid $4.7 million contract.
Thomas C. Lester M.D., who has long been doing business as Liberty Healthcare of California, Inc., has had an exclusive contract with the county of San Bernardino since June 22, 2010, having first gotten that work as the provider of services under what was referred to as a “pilot program,” thereby bypassing the need for competitive bids. Since that time, his contract has been renewed without any competitive bidding.
While the first contract Lester’s company landed with the county for the three-year period between July 1, 2010 to June 30, 2013 specified a not-to-exceed $499,977 annual cost, not including the cost of medication, the contract approved this week zoomed to more than nine times the original cost, $4,756,536 for the period from June 1, 2015 to May 31, 2016.
Once a trial court finds a defendant mentally incompetent to stand trial and orders the defendant committed to a state mental hospital for care and treatment to restore competence to stand trial, the state mental hospital has 90 days to make a written report to the court concerning the defendant’s progress toward recovery of mental competence.
According to Kathy Wild, the sheriff’s department’s health care administrator, “The demand for restorative programming and treatment at the state hospital has been increasing over the past decade so that many individuals are forced to wait in the county jail for months until a bed is available. This wait creates an extended period of incarceration for the inmate and excessive delays in the adjudication of their criminal charges.”
As part of an effort to clear the county’s jails of this backlog of inmates awaiting admission to the state mental hospital system, the county in 2010 hit upon the idea of bringing in a psychiatrist who would provide to those inmates in the county jail the same services those inmates would receive in the state mental hospital.
According to San Bernardino County Sheriff’s Department Captain Shannon Dicus, “The California Department of State Hospitals is responsible for returning to competency individuals charged with a felony who have been determined to be incompetent to stand trial by the California Superior Courts. Once an individual is committed to a Department of State Hospitals facility for treatment, the facility has 90 days to make a written report to the court concerning the defendant’s progress toward recovery of mental competence.”
Currently, The California Department of State Hospitals has insufficient beds within the state hospitals, thereby creating lengthy waiting lists of inmates in county jails, including those in San Bernardino County, who are in need of mental competency restoration services. To address this shortage, the California Department of State Hospitals is contracting with the sheriff’s department to provide access to portions of the West Valley Detention Center to administer the Jail Based Competency Treatment Program and provide inmates, from both Los Angeles and San Bernardino counties, with restoration of competency treatment services similar to those provided in state mental hospitals, for up-to 76 patient inmates.
“This program would allow inmates to begin treatment faster and significantly decrease the time these individuals remain incarcerated due to a faster adjudication of their criminal charges,” according to Dicus.
“In May of 2010, the California Department of Mental Health contracted with Liberty (State Agreement No. 09-79156-000) to establish a pilot program to provide restoration of mental competency services in a county jail. On June 22, 2010, the board of supervisors approved a revenue agreement with Liberty to allow West Valley Detention Center to be used as a site for a state pilot program to provide restoration of mental competency services to county inmates. The sheriff’s department allocated 20 beds in a sheltered housing unit for use by Liberty and assigned a deputy to provide security for Liberty’s staff. On June 4, 2013 the board approved Agreement No. 13-367 to continue the program until June 30, 2016.
“To expand the program and maintain the continuation of services with the additional capacity,” Dicus continued, “approval of the contract with Liberty on a non-competitive basis is recommended. The proposed contract will allow for a team of licensed clinical personnel to work approximately forty hours per week, and provide Jail Based Competency Treatment Program patient inmates with treatment services such as: mental illness management, prescription of psychotropic medications, competency restoration, physical stimulation, mental/social stimulation, and other components required by applicable state law and regulations. Additionally, Liberty personnel will comply with all the state’s reporting requirements on the progress of the program’s patient inmates. [The county department of] Purchasing concurs with the non-competitive justification.”
The county’s costs on employing Lester another year are not limited to the $4.756 million. The sheriff’s department will allocate space for 76 beds in the West Valley Detention Center’s sheltered housing unit for the use by Liberty; and will provide office space, furniture and security for Liberty’s personnel. Nor will Liberty cover the cost of medicine to be provided to the patients/inmates. Routine inmate healthcare, including medications, will be provided through the department’s existing pharmacy, medical records and medical service delivery systems. To meet the operational needs of the contract, the sheriff’s department will add a combination of safety and general employee positions in Fiscal Year 2015-16. At the end of the contract, the sheriff’s department would transfer incumbents in the California Department of State Hospitals contract-funded positions into existing vacant budgeted positions or delete the positions through attrition. The contract term with both parties is June 1, 2015 through May 31, 2016. The sheriff’s department was unable to extend Lester’s contract on it own authority as County Policy 11-05 requires board of supervisors’ approval for services in excess of $100,000. The proposed contract with Liberty includes two one-year options to extend, provided that an extension of the county contract with the California Department of State Hospitals is approved.
By utilizing a psychiatrist to provide mental competency restoration services to inmates deemed to be mentally incompetent within the jail setting as opposed to transferring them to a state mental hospital, the county stands to obtain reimbursement of $10,857,697.44 from the state.