State pushes to privatize services: Proposed change to Mental Health Dept. raises concerns

Governor Nikki Haley

Renee Ittner-McManus

The S.C. Department of Mental Health is considering privatizing care for about 200 mentally ill patients who have committed crimes and 120 sexual predators.

The move to privatize services is being championed by Gov. Nikki Haley, who has ties to one of the potential bidders.

The decision alarms Mental Health employees, who worry they could lose access to state benefits just as they near retirement, and some mental health advocates who worry patients will not receive the same quality of care that they get now.

But others say private firms can improve patient care, noting most states already have privatized such care.

The agency asked for bids to privatize care for more than 300 people. However, it pulled that request for bids off the table last week after potential bidders raised questions about how much space the mental health care programs would need in the future.

Brenda Hart, deputy director of administrative services with the Department of Mental Health, said the agency does not know whether it will put the project back out for privatization bids.

The state privatized some mental health services a decade ago. The company that won that contract, Florida-based GEO Care, is expected to compete for the additional services if they are rebid.

To bolster its bidding position, GEO Care, whose operations sometimes have been marked by controversy, has hired George Gintoli, a former director of the state Department of Mental Health. Its parent company also contributed $3,500 to the Republican Governors Association's effort to elect Gov. Nikki Haley last fall.

Haley has told the cabinet agencies that report directly to her to look at state services that can be privatized. However, the Department of Mental Health is not part of Haley's cabinet. Its director reports to a seven-member board that is appointed by the governor.

'If doing so saves money and provides better services to the taxpayer, then the governor is absolutely for privatization, and her cabinet agencies know that where they find opportunities that fit those criteria, they should explore them,' Haley spokesman Rob Godfrey said in a statement. 'The governor herself will continue to work toward the privatization of things like school buses, workforce centers and educational television.'

Privatization effective?

The state privatized support services, including nursing and food service, for the Department of Mental Health program in the early 2000s, in part because of the cost of replacing crumbling facilities, said Mark Bickley, attorney and spokesman for the agency.

The agency has seen some of the deepest budget cuts in state government since 2008, and, Bickley said, privatizing services could reduce state costs, and provide facilities, staff and expertise.

'We think overall the contract has been working well,'

Bickley said. 'We are trying to run a program as economically as possible.'

South Carolina is one of just a handful of states that maintains a central state agency for mental health care.

For example, North Carolina's entire mental health program has been privatized for about a decade, said Debbie Dihoff with the North Carolina branch of the National Alliance on Mental Illness.

But Dihoff is critical of privatization, saying it has come at the expense of patient care. A private business, Dihoff said, has no incentive to rehabilitate patients and move them back into society.

'What we've learned is that, frankly, it doesn't work for this population,' she said. 'Their whole thing is they have to keep the beds full in order to make money.'

But state Rep. Kris Crawford, a Florence Republican and emergency room physician, said private providers can do the work cheaper and better integrate care of patients' mental health and other medical issues. Privatizing mental health care also can help keep mental health patients from seeking more expensive, less effective emergency room care, he said.

'This is something the private sector does, in fact, seem to do better,' he said.

‘Outside the box'

GEO Group and its subsidiaries have a spotty reputation for their operation of private prisons and other facilities. The company pulled out of a private prison it ran in Pennsylvania in 2009, after eight deaths in four years and a number of lawsuits.

According to documents obtained by The State, an April investigation by the Lieutenant Governor's Office on Aging concluded GEO Care employees forced a South Carolina patient at the company's Columbia facility into the shower at 3:15 a.m., hosed him down, and left him bruised and scratched. It was the second time the patient had been forced to take a shower in the middle of the night within a month.

GEO Group could not be reached for comment.

Bickley said abuse has been reported and investigated in state-run programs, as well.

GEO Care has addressed concerns raised by the state in the past, most often for having too few nurses working in the privatized S.C. unit. Every time the state has raised an issue, GEO Care has responded, Bickley said.

Bill Lindsey, S.C. director of the National Alliance on Mental Illness, said his group is of two minds on the issue.

Privatizing could maintain services that would otherwise be axed because of budget cuts, he said.

The privatization also could impact dozens of state employees, who could lose their jobs or access to state benefits.

Sen. John Scott, D-Richland, said senators were prepared to set aside money in the state budget to help Mental Health agency employees who lost their jobs in a privatization get access to their retirement benefits.

State law requires the state to pay half the cost of buying additional service time that a state employee needs to be eligible for a full pension if the state privatizes a program. However, workers would have to use their own money to pay the other half of the cost.