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Sacramento Bee

July 22, 2010

Sacramento County mental health cuts blocked by federal judge

By Cynthia Hubert and Denny Walsh

A federal judge Wednesday blocked Sacramento County from cutting mental health services as a way to balance the budget, ruling the proposed changes violate the federal law that protects disabled Americans.

U.S. District Judge John A. Mendez found that the county's plan, which would shift thousands of county patients from community outpatient programs that have served them for years, would cause "catastrophic harm" and violate the Americans with Disabilities Act.

The ruling was a victory for disability rights lawyers who filed a lawsuit challenging the cuts, and followed a highly unusual decision by the U.S. Department of Justice to weigh in on the case. Justice Department lawyers, in a statement filed Wednesday morning, agreed that the cuts would violate constitutional law and urged Mendez to issue a preliminary injunction blocking the county's plan.

The ruling is yet another blow to the county's efforts to shave tens of millions of dollars from its budget by making cuts to critical programs. Earlier this month, a Sacramento Superior Court judge blocked scheduled cuts to medical programs for the poor, ordering that clinics slated for closure remain open. A separate lawsuit on the mental health cuts is pending in Superior Court, and the county faces legal action in connection with its cuts to the Probation Department.

The legal challenges may force the county to find other ways to deal with a yawning budget deficit that at one point stood at $181 million. The cuts to mental health services were part of a spending plan the Board of Supervisors approved last month that included layoffs of more than 600 workers affecting virtually every county department.

County counsel Robert Ryan said Wednesday it is unclear how the final numbers will shake out, given the lawsuits and the uncertainty of the state's budget situation. "We'll have to reconcile what the state does with more refined revenue and cost projections in our final budget," which will be addressed in late summer or early fall, he said.

As for mental health programs, Ryan said, the county will develop a proposal that more clearly describes how services would be delivered under a new system. He declined to comment further, saying that the judge had yet to issue his written decision.

Wednesday's court action sent a wave of relief through mental health clients who, as of Aug. 1, faced losing access to the county-funded community programs they say have kept them stable.

"A huge weight has been lifted from my shoulders," said Leslie Napper, 41, who for the past eight years has been getting care for bipolar disorder at Northgate Point, one of the programs under the gun. "For now, at least, we're not going to have to give up the services that we rely upon for our well-being."

Over the past year, prior to the latest round of cuts, the county's outpatient mental health programs were slashed by more than half. The county also has closed 50 of 100 inpatient beds at its mental hospital on Stockton Boulevard.

In the federal case on Wednesday, Mendez issued a preliminary injunction barring the county from switching Medi-Cal patients like Napper to a controversial new system of outpatient care. Under the proposed plan, thousands of patients would get care at county-run clinics instead of private community treatment programs funded by the county.

The county had outlined a plan for transferring as many as 4,000 patients into new programs beginning next month, contending patients would get better, streamlined care under the new system. Some private providers and patients disagreed, arguing the proposal was vague, things were happening too quickly and clients would fall through the cracks.

"The county was proposing to blow up an existing system that served patients well for 17 years, and not providing enough information about what would replace it," said Stuart Seaborn of Sacramento, lead attorney for Disability Rights California. "Needless to say, our clients were scared."

Disability Rights California, the Western Center on Law and Poverty, and Cooley LLP filed the suit in May on behalf of five mental health patients, including Napper. The changes cannot go forward until the court case is resolved, Mendez ruled.

Napper said her community treatment program has helped her manage her medications and symptoms and avoid relapses. She said she "had no idea" where she would have been getting care as of Aug. 1. "The county gave me a phone number to call, but it's just a voice mail and I got no call back."

U.S. Justice Department attorneys agreed with advocacy groups that the proposed changes to the system would be so disruptive that many patients likely would end up in jails and institutions for lack of care. The "unnecessary hospitalizations and institutionalizations" would cost the county more than maintaining current services, they said.