December 1st, 2012

Audit finds violations at Conn. state mental health agency

The Connecticut state auditor’s office recently released the report from its bi-annual review of the Department of Mental Health and Addiction Services (DMHAS). Auditors discovered several violations during the review and recommended corrective action to the department.

The audit, which took a year-and-a-half and 4,800 man-hours to complete, evaluates compliance with financial laws, regulations and contracts and assesses internal policies and procedures designed to ensure adherence to those guidelines. This review uncovered several areas of concern previously non-existent. Some of the more egregious violations included discrepancies in furlough time and compensation; mismanagement of patient funds; misuse of cell phones; excessive use of consultants; and employment of a retired state worker, among others.

James Siemianowski, director of evaluation, quality management and improvement for DMHAS, acknowledged the existence of the identified issues and says his department has moved quickly to address the problems. He notes that some of the issues have already been addressed, while action regarding others is in progress. “For instance, [regarding] overpayment related to furloughs, we have recovered all the funds associated with that,” he says. “[As for the issue of] client funds at one of our facilities, we have instituted a number of internal controls associated with that. Duties related to client funds have been segregated. A second staff person counts and verifies cash distribution. Our policy and procedure has been updated and we’re doing spot checks to make sure people are following procedures.”

The issue of greatest concern in the report revolves around staffing, according to Siemianowski. “This is largely a recruitment issue. While we are taking steps to reduce the amount of money we pay, it’s dependent on if [psychiatrists] will take our pay scale. At the core, it’s difficult to attract psychiatrists into the state system,” he says, emphasizing that funding is not the issue.

William Quinn, auditor for DMHAS, reports that an annualized starting salary for psychiatrists is $120,000, which breaks down to $57 per hour. He points out that psychiatrists can earn more money working in private practice than they can working for the state.

Casting a wider recruiting net, DMHAS has been proactive in pursuing viable hiring alternatives. “We have a collaborative relationship with Yale,” Siemianowski says, citing a fellowship program. “We are also looking to get assistance from a law firm with Visa applications for appropriate foreign nationals and we’re looking to do a residency program with the UConn Medical School.”

According to the report, DMHAS had contracted with seven psychiatrists, all of whom exceeded the six-month maximum employment limit as mandated by the state; one worked for at least 20 consecutive months and another, for 30 consecutive months. Additionally, one of the contracted psychiatrists was a retired state worker who was receiving state retirement benefits, an explicit violation of state law.

State auditor Robert Ward says that his office looked at expenditures in prior years and found a significant increase in payment to contracted psychiatrists. He says the expense jumped from $600,000 in FY 2008-2009 to $3.2 million in FY 2010-2011.

While the state auditor’s office discovered these discrepancies, it is not empowered to hold DMHAS accountable for fixing them, according to Ward. “Under state statute, we can make recommendations, but can’t enforce them. It’s the responsibility of the agency.” He adds that the state auditor’s office may conduct independent checks on certain violations and will examine all issues during the next scheduled audit.

Siemianowski emphasizes that DMHAS did not dispute any of the findings in the state auditor’s report and that the department is working diligently to correct them. “We take this matter seriously,” he says.

By Phyllis Hanlon

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