‘There’s winners and losers’: Colorado is hoping to reform mental health, but a failed overhaul in 2014 shows how political connections maintain the status quo

As Colorado start a brand-new effort to change the shipment network for psychological healthcare in the state, the occasions of 2014 deal a check out just how hard it can be to enforce adjustment on the politically linked, deeply-entrenched team of community-based service providers that have actually handled the system for years.

That year, everybody from the guv to the head of the state Division of Person Solutions as well as legal leaders revealed their objective to transform the system as well as boost accessibility to psychological take care of inadequate Coloradans in situation.

However after a quote was granted to a brand-new carrier with a cutting-edge strategy, the state turned around program, sweeping apart their stated need for reform as well as testing their very own proposal treatments. After that, when the winning prospective buyer additionally  won in court, the present service providers actioned in, clearing up the situation, tightening their hang on psychological health and wellness therapy in the state as well as relatively completely removing the largest danger to their prominence they had actually ever before encountered.

Specialists at the state that had actually lengthy helped adjustment were squashed.

“That was one of the most hard, most likely, time in my profession I have actually ever before had,” claimed Chris Habgood, a previous staffer at the state Division of Person Solutions that created the prepare for adjustment in the 2014 initiative. “Due to the fact that when you recognize you’re doing something that is the appropriate point to do, to assist individuals, you’re so fired up regarding developing this brand-new system that will certainly assist Coloradans. 

“And after that suddenly it concerns a collapsing stop due to the fact that the solution shipment system really did not like what the result was … there’s victors as well as losers, as well as the losers really did not like shedding as well as they were gonna make certain that they were not the losers.”

In collaboration with COLab as well as wire service throughout the state, mouth-to-mouth resuscitation Information has actually invested months analyzing just how Colorado’s system for dealing with individuals that are both inadequate as well as emotionally sick became, as well as just how it has actually made it through difficulties to its framework. 

Previous tales from the consortium have actually demonstrated how a few of the state’s  17 community-based psychological health and wellness service providers have actually fallen short to give therapy to the most difficult as well as most pricey situations while preventing competitors.

And also while the business mention that hundreds of individuals are assisted with the system yearly, researches have actually revealed that Colorado has the highest possible price of grown-up mental disease in the country as well as among the most affordable prices of accessibility to care. 

George DelGrosso, that in 2014 looked after the Colorado Behavioral Wellness Council, the lobbying team that stands for the existing service providers, did not return several messages looking for remark. Doyle Forrestal, that replaced DelGrosso as head of the CBHC in 2015, claimed she thinks the regards to the 2014 negotiation prevent her from discussing it. She decreased a meeting, as well as declared it was illegal to talk about information of the facilities’ secret contract to suppress the rival. 

The present head of the Jefferson Facility for Mental Wellness, which was amongst the facilities that drove the negotiation, kept in mind that it took place under previous management, as well as examined why mouth-to-mouth resuscitation Information as well as COLab were remaining to analyze the efficiency as well as background of the present service providers.

“It appears there exists an intent to damage the stability as well as online reputation of neighborhood psychological university hospital, each time when it is vital that we continue to be readily available to hundreds of individuals in our neighborhood that require as well as rely on the treatment we give,” created Kiara Kuenzler, head of state as well as chief executive officer of the Jefferson Facility for Mental Wellness, in an e-mail to mouth-to-mouth resuscitation Information. “Jefferson Facility offers greater than 25,000 individuals yearly, as well as CMHCs offer greater than 200,000 individuals throughout Colorado yearly.” 

“We have a responsibility…”

On Dec. 18. 2012, 5 months after the Aurora movie theater capturing as well as on the eve of the state legal session, Hickenlooper stood in front of the media as well as revealed the strategy to spruce up psychological health and wellness therapy in the state.

“We have a responsibility to take a look at just how we assist each various other,” claimed Hickenlooper. “I think these plans will certainly minimize the likelihood of poor points occurring to great individuals.”

The information captured the focus of David Covington, an exec at a behavior health and wellness firm in Phoenix metro, AZ. 

“This was a nationwide tale,” Covington informed a Denver Area Court court in 2014, according to court recordings gotten by mouth-to-mouth resuscitation Information. Covington indicated that Hickenlooper as well as his group “actually desired reducing side. They were looking for technology. They desired neighborhood partnership in such a way that they had not seen prior to. I believe that was what actually attracted us to this possibility.”

Covington had actually invested a profession in psychological health and wellness solutions, beginning as a certified therapist, functioning his method as much as an executive duty with Magellan Health and wellness Solutions, which had the agreement to offer Maricopa Area, covering Phoenix metro. At one factor they offered 100,000 energetic customers in the area.

However Covington, after listening to information of what Hickenlooper intended to do, made a decision Colorado would certainly be his brand-new residence. 

“We assumed this is where the nation’s going,” claimed Covington. “This is what individuals will certainly be considering. So we intended to bring the A-team to that.”

That would certainly initially call for some acrobatics on Covington’s component. Habgood claimed that in feedback to the lobbying by the existing service providers as the brand-new regulation functioned its method with the General Setting up in 2013, the state would certainly be limited to picking just a Colorado-based firm to give the situation solutions required as well as moneyed in the brand-new expense.

So Covington indicated he touched the most effective in psychological health and wellness situation solutions throughout the nation as well as with each other created a Colorado firm called Dilemma Gain access to of Colorado. He tendered his resignation from the Arizona firm, so his return to might be contributed to the proposition to Colorado. 

His wager settled.

On Oct. 16, 2013, Colorado educated Covington that Dilemma Gain access to had actually won the proposal. 

In an inner letter at the Colorado Division of Human Being Solutions, Habgood contacted the head of purchase, “the Board located Dilemma Gain access to of Colorado’s propositions to be one of the most cutting-edge, incorporated as well as recovery-focused propositions for changing Colorado situation shipment throughout the state.”

A privacy arrangement binds the events from the 2014 fit, as well as Covington claimed he might not comment. However he informed the court that he threw away little time.

“Quickly we got on the ground right here,” Covington indicated. “I was considering residences to relocate right here, considering colleges, starting to craft out just how we would certainly involve staff members in the hiring of 150 to 200 plus team right here in Colorado.”

2 weeks later on the ecstasy of the notification of honor of agreement would certainly come collapsing down. Covington was informed initially that the ask for propositions procedure was under examination by the state, as well as within weeks he was educated he would certainly not obtain the agreement, that the program would certainly head out to bid once more. 

He was additionally educated that his rivals – the state’s existing facilities – obtained a duplicate of his complete proposition, however he couldn’t obtain a duplicate of theirs. 

“It was really irritating,” indicated Covington. “We had actually very carefully considered what we really hoped would certainly be a winning technique, as well as created business, took their distinct product as well as fused them right into something that had actually never ever been done prior to.

“Which affordable benefit was currently readily available to entities that had actually ended up second to us in those 4 areas. So it seemed like our affordable benefit was totally removed by what appeared like a really unreasonable procedure.”

So Covington filed a claim against the Colorado Division of Person Solutions to quit an additional proposal procedure. What resulted, according to statement assessed by mouth-to-mouth resuscitation Information, was a peculiar placement of moving rate of interests in which the very same state company that desired affordable bidding process suggested that its very own procedure was flawed. At the very same time, the state’s existing facilities that shed the proposal operated as darkness accuseds unrevealed in the fit, however sustaining the  state’s lawful technique. Eventually they resolved the situation themselves in the secret contract.

“Obtaining a lot stress from the Guv’s workplace”

Virtually from the minute the legislature elected to call for the brand-new program to be competitively proposal, there was problem at the state regarding the response of the existing facilities, stood for by the Colorado Behavioral Wellness Council, CBHC, as well as its effective leader, George DelGrosso.

Quickly after the state revealed Covington’s firm won the proposal, an e-mail entered Habgood’s inbox from his manager Patrick Fox, that created, “That is mosting likely to speak to George?”

The shedding prospective buyers comprised DelGrosso’s board, standing for facilities from every edge of the state: AspenPoint (currently Diversus Health and wellness), Neighborhood Dilemma Link (a team included the city location facilities), Northeast Behavioral, as well as an associate of Mind Springs.

Harriet Hall, that ran the Jefferson Facility for Mental Health and wellness at the time as well as belonged to the Neighborhood Dilemma Link team that bid on the situation program sent out an e-mail to advocates, claiming “We are checking out all lawful choices for evaluation of the honors procedure…”

At risk was a situation program that at the time was forecasted to include regarding $45 million in brand-new cash for solutions, simply for the initial 2 years. However past that, the access of Covington’s brand-new firm right into a market that had actually been regulated by the community-based facilities for years guaranteed to interfere with the shipment of psychological healthcare in Colorado in brand-new as well as uncertain means.

E-mails went into as proof together with statement in Covington’s fit suggest that the teams utilized their internet of political links to tax the Division of Human Being Solutions as well as the guv’s workplace to eliminate Covington’s cutting-edge proposition, according to Covington’s lawyers. 

The leader of Person Solutions at the time, Bicha, rapidly purchased an evaluation of the RFP procedure by a different state company, the Division of Worker as well as Management. The company created a brief, one web page recap of its searchings for, which CDHS trusted to terminate the proposal honor, according to proof provided in court.

The Denver Area Court court located the recap to be “rigged” by the state in a purposeful initiative to rescind the proposal. The complete DPA examination wasn’t delivered to Bicha until after the RFP was invalidated.

Covington’s lawyer, Todd Miller, relying on email evidence, provided his theory to a Denver judge of why the department did that.

Leadership at CDHS were “getting so much pressure from the Governor’s office, that all they wanted was some cosmetic cover, which they thought they had in that one page summary to cancel.”  

People who had been a part of scoring the bids were surprised when there were suddenly concerns.

Chris Olson, then the executive director of the County Sheriffs of Colorado was on the RFP committee. Law enforcement officials tracked the process closely because, until that point, deputies and police officers had often been responsible for dealing with and transporting people undergoing mental health crises. He remembers an interview he did with state investigators from DPA.

“Gave them pretty much what I’m telling you right now,” said Olson in an interview. “That I thought it was a fair process and that we were not motivated politically on this. And, yeah, the out-of-state firm got it. I mean, there’s nothing wrong with that. That’s just, they won the bid.”

Despite the lopsided scores in favor of Crisis Access of Colorado, David Covington’s company, and despite the participants in the RFP committee at the state feeling that it was clearly a fair process, leadership at CDHS canceled the RFP and announced they were putting it out for bid again.

The existing centers declared victory, sending out an email thanking supporters for putting on the pressure. Harriet Hall, at the Jefferson Center for Mental Health, wrote: “I know that many of you expressed your concern to CDHS and/or the Governor’s office, and I want to thank you for this. I believe that the concerns expressed by many of you and the strong community support were vital to this solution.”

Though the additional funding and creation of a new system for delivering crisis mental health services was a signature initiative for Hickenlooper, those who ran his office said they couldn’t recall much, if anything, about how the 2014 effort unraveled.

In an interview, Roxane White, Gov. Hickenlooper’s chief of staff at the time couldn’t recall anything about the episode. 

She suggested reaching out to Hickenlooper’s then-chief strategy officer, Alan Salazar, who is now chief of staff to the Denver mayor. Salazar also couldn’t recall anything about the crisis services controversy. He suggested Katherine Blair Mulready, who was a health care specialist in Hickenlooper’s office.

“I remember that the original bid was given to an out-of-state entity without an existing footprint in Colorado,” said Mulready, in an email. “And that when that was announced, the community mental health centers were very upset. While I don’t remember any specific conversations on this topic, I spoke with leadership of CBHC – the trade association for the CMHCs/BHOs – frequently during my tenure in the Gov’s Office (2011-2014), and the issue may have come up in discussions with them.”

Pressure was intense from the state legislature too. Then-state senator Irene Aguilar who sponsored the law that directed money to the program sent emails that made their way to the Department of Human Services that were described in testimony as pointed. It’s unknown exactly what she said, but it was revealed in court that it helped prompt specific inquiries in the internal review. Aguilar did not respond to multiple requests for comment. Her emails were introduced as exhibits but are no longer in the court file.

In court, Covington’s lawyers focused on the impact of Aguilar’s concerns, which were forwarded down the chain of command at CDHS to Clint Woodruff, lead of the Division of Financial Services, who officially initiated the DPA review and ultimately invalidated the bid. 

“Particularly Senator Aguilar’s email,” said Todd Miller, Covington’s lawyer in closing arguments on the preliminary injunction. “That very day, all of a sudden, we get a notice that the DPA is going to be asked to review this thing, and an email that says ‘Clint, be sure when the DPA looks at this, they take care of Senator Aguilar’s concerns.’”

In an interview, Woodruff denied there were any political motivations behind invalidating the bid. “I was asked to do a review just because it was a lot of money,” said Woodruff. “It was a very significant bill, right?” 

Woodruff said that the request to review the bid came from his boss at the time Susan Beckman, and he maintains that there were fatal flaws in the process and the bid deserved to be invalidated. 

Multiple messages left at phones listed as belonging to Beckman were not returned.

Emails also came from Dean Toda, who handled media for the State House Democrats at the time, checking on the status of the bid.

CPR attempted to obtain copies of the emails, but the exhibits could not be located by the court.

“a manufactured reason”

After listening to testimony over four days in early 2014, the judge agreed with Covington’s attorneys and issued a preliminary injunction to stop the second RFP from going forward.

The judge said from the bench that the state’s cancellation of the first RFP, “just defies reason … and it does suggest a manufactured reason to cancel, a trumped up reason, whatever you want to call it.”

The judge also called out the state for giving copies of Covington’s winning bid to the losing bidders, allowing the existing centers to potentially incorporate his already state-endorsed ideas into their proposal.

Bicha, in an interview with CPR News, disputed that there was any outside pressure, from the existing centers or the governor’s office to overturn the bid results.

“No, there had not been pressure to do it from outside. The pressure was internally and mine,” said Bicha. “I had concerns about their approaches and methodologies. And so I asked DPA, ‘would you independently review the work that my team had done, because I didn’t have confidence in what I was seeing.’ So that was the nature of the request of DPA. There was no political pressure.”

(AP Photo/Brennan Linsley)

Whatever the motivation, crisis mental health services were now on hold after the preliminary injunction. The state and the existing centers appealed all the way to the state supreme court, but the appeals were all denied. 

The state and the centers entered into mediation with Covington and his company Crisis Access to seek a settlement.

Eventually, he agreed to drop his lawsuit as long as a “separate agreement” was reached between the existing centers and his company, Crisis Access. The separate agreement is not a state record, and not subject to open records laws. It’s unknown how much, or even if, the centers paid Crisis Access to drop the claim against the state.

Also unknown: Where any funds that might have been paid to Crisis Access would have originated. The centers and CBHC refused to say, citing the non-disclosure agreement. The publicly available tax returns for the non-profit centers involved, which derive their revenue from a mix of state, federal and private funds, reflect no payments to settle claims. The centers refused to disclose the terms to CPR News. 

What is known is that, though his department was a defendant in the case, Bicha was not in the meeting outside of court when the deal was reached between the centers and Crisis Access. The case just went away.

“From our perspective what happened was the two of them reached some sort of agreement,” said Bicha. “We never were notified of what the terms were. All we know is that the lawsuit’s going away.”

Asked if he had questions about the nature of the settlement, Bicha said, “Absolutely, but we had no right to find out what the settlement was,” since it was settled between two private parties in mediation. 

But even while arguing that he wanted the system to change and that he had little choice in the decisions surrounding the crisis care contract in 2014, Bicha also still questions the entire structure of behavioral health delivery in the state, as the legislature tries to begin a realignment.

“These nonprofit corporations have guaranteed no-compete contracts with the state,” said Bicha. “But they don’t have accompanying transparency into their financials, into lawsuit settlements, to board appointments, into all of those other factors that the public ought to be able to see and know about if they’re going to get nearly exclusively state and federal dollars in no compete contracts.”

David Covington said he could not comment. He now runs a widely respected crisis mental health services company called RI International, based in Arizona. The company has direct care services in nine states, but not Colorado. Covington and RI’s approach is routinely cited in best practice guidelines by federal agencies and national behavioral health associations. 

Experts in the field said the decision to reverse the award to Crisis Access meant Colorado missed out an opportunity to become a national model for crisis mental health care management.

David Covington and RI International have, “really been at the forefront of what a crisis system should look like,” said Dr. Amy Watson, a professor in the Social Work Department at the University of Wisconsin-Milwaukee. 

Watson was surprised to hear that Covington was essentially kicked out of Colorado. “He really has pushed things forward” in behavioral health innovation.

With Covington out of the picture, the state awarded the contracts and additional funding for crisis services to the existing centers. 

The centers ran services up until they found themselves battling the state again.

In 2018, Human Services again put the crisis services out to bid. This time, the center’s trade group, CBHC, sued the state directly, claiming changes to the existing system were unneeded.

But by bringing the program back to court, it allowed for some unflattering testimony, making clear that the existing centers, especially Mind Springs, which managed the crisis services for the Western Slope, were not fulfilling key parts of the 2014 contract they had fought so hard to win. 

The assistant Summit County manager Sarah Vaine testified that she saw a map once that indicated the county had mobile mental health crisis services, supplied by MindSprings.

“It says we have this in our community,” testified Vaine, yet it was not actually available in the community. 

The attorney for CBHC and Mind Springs asked how Vaine knew that.

“It’s based on community experience of calling the crisis line and being told to go to the emergency center and then having the CEO, and the local director, say ‘we won’t go to people’s homes because there could be a risk to our staff.’ And I then said, ‘well, you could call dispatch and ask for someone to go with you. And they said, that’s not part of our policy.” 

Staffers from the state’s Department of Human Services said that those problems were really widespread. Habgood said in an interview that for all the people who are well served by the community-based centers, there are still times when they fall short.

“They do great work. They really do. They do serve people really well. And I want to be very clear on that is, and it’s not just cuz I had relationships with them,” Habgood said. “There are people who are being served. There are times where they…they don’t always do good.”

A Denver District Court court dismissed the 2018  lawsuit from the bench, ruling on the narrow grounds that the state is entitled to put programs out to bid if they see fit.

The centers never bid on the new program. A group of so-called Administrative Services Organizations, or ASOs, now manage the state’s crisis services. It was meant as a way for the state to diversify away from the community psychological health and wellness centers a bit, but the centers still provide the majority of mental health services in the state by contracting with the ASOs.

Still, the lawsuit sent a message.

“I think it’s an intimidation tactic, right?” claimed Nancy VanDeMark, the former head of CDHS’s Office of Behavioral Health. “If you make it so difficult,” the state will think twice about adding competition to the existing centers.

“And also I believe it’s been to some extent effective.”