From The Oregonian, August 10, 2001

The Multnomah County Board of Commissioners on Thursday unanimously approved the first phase of the county’s long-awaited mental health redesign.

Commissioners also approved a budget outline for the acute-care plan but postponed until next month more specific — and potentially wrenching — decisions about how to pay for it.

With the backing of the 5-0 vote, board chairwoman Diane Linn said, “I believe the system will begin its road to recovery.” She called reform of the mental health care system “bar none, the most important thing we’ve considered, at least during my tenure” on the board.

“There’s an old saying that if it ain’t broke, don’t try to fix it,” said Commissioner Lonnie Roberts. “Well, it is broke.”

Thursday’s action capped two years of debate and a week of particularly intense negotiations. The wording of the agreement on mental health was not decided until minutes before the meeting started Thursday morning.

“If they had let this reform effort grind to a stop, they would have abdicated their responsibility for mental health care in this community,” said Jason Renaud, director of the National Alliance for the Mentally Ill in Multnomah County. “We’ve been talking about this for months.”

Commissioners approved the first six of 18 proposed “action steps” in the latest version of a plan for acute mental health care. That plan is sometimes called Phase 1 or the Gap Plan, because it tries to fill the gap left by the closure of the Crisis Triage Center at Providence Portland Medical Center on July 31. But parts of the plan also reach beyond the immediate gap in crisis services.

The approved steps include crisis phone lines, walk-in clinics, mobile crisis teams, a secure unit for evaluating patients deemed dangerous, improved alternatives to hospital beds and better coordination of acute care. They are designed to reduce costly hospital care by helping patients deal with a mental health crisis before it reaches the point at which a hospital stay is necessary.

Planners expect the redesign to reduce hospital costs by $3.6 million during the next three years.

The resolution also adopts recommendations of the county’s Cultural Competency Committee, aimed at ensuring that caregivers have the knowledge and skills, including linguistic fluency, to meet the needs of underserved racial or ethnic groups. Those groups include African Americans, Latinos, Asian Pacific Islanders, Native Americans and Eastern Europeans.

The importance of cultural competency was dramatized in April, when Jose Santos Victor Mejia Poot, a 29-year-old Mexican national, was fatally shot during an altercation with police at BHC-Pacific Gateway Hospital.

The latest plan pledges not to cut outpatient alcohol and drug treatment or services aimed specifically at children or minority populations.

“A single omnibus contract will not be offered to a single provider for mental health services,” the resolution states. Community groups and some specialized providers of care had worried that the redesign would consolidate all outpatient treatment into one giant contract that would leave them at a disadvantage.

Commissioner Serena Cruz said the really hard decisions would come Sept. 20, the new deadline for submission of a line-by-line mental health budget. “At this point,” she said, “we’ve got ideas about where the money will be coming from, but we don’t have specifics.”

The business plan approved Thursday reflects a consensus over categories of spending and revenues, but it allows for tweaking of specific numbers during the next six weeks.

“We have to come back next month with the line-item, nitty-gritty stuff — down to paper clips, basically,” said Jim Gaynor, the county’s chief of mental health redesign.

“It’s a very complicated thing, to redesign a system,” Dave Warren, county budget director, told the board. “So I’m asking you to be patient with the numbers. The numbers are going to move.”

Dale Jarvis, an accountant and consultant hired by the county to prepare the redesign’s budget, said Thursday’s votes by the board were “the best possible outcome,” given the difficulty of the negotiations. They allow the county to move ahead on contracts with mental health providers, he said, while giving officials six more weeks to crunch final budget estimates.

To cover a projected $7.5 million shortfall for acute care this year, the business plan suggests several strategies. These include cuts in administrative costs for the Behavioral Health Division of the county’s Department of Community and Family Services and Verity, the agency through which public mental health funds flow. That could eliminate 14 administrative jobs.

The plan also authorizes use of $1.7 million of the estimated $2.5 million in the county’s mental health reserve fund for emergencies.

From the Portland Tribune, April 6, 2001

Family’s attorney will conduct an inquiry into death of mental patient

An attorney for the family of 29-year-old Jose Santos Victor Mejia Poot, who was fatally shot by a Portland police officer at a psychiatric hospital last weekend, will continue her own inquiry into circumstances that led to Mejia’s death last Sunday.

“The family has a number of important questions in terms of practices and policies,” said Linda Friedman Ramirez, a Portland attorney. She said at a press conference Thursday that she will speak with the district attorney’s office and consult police experts about the shooting. “We need more information. We certainly have things that are a reason to be concerned about.”

Consul General of Mexico Alma Soria Ayuso said she has asked Chief Mark Kroeker to keep the consul informed of the results of the Portland Police Bureau’s investigation into the incident as soon as it is available.

Carlos Mejia, the victim’s brother, said through a translator that he is saddened “particularly because of the manner we were informed this occurred.” Ramirez said the family was not informed of the Sunday evening death until Monday, through the Mexican Consulate. “We want to know the truth of how it is that all this took place,” he said.

The victim’s father, Pedros Mejia, did not comment, but held his head in his hands and wiped tears from his eyes.

Mejia, a native of Mexico’s Yucatan state who lived in Northeast Portland, died from gunshots to the head and chest last Sunday evening at BHC-Pacific Gateway Hospital in Sellwood. The series of incidents that led to the shooting began Friday morning when officers were called for assistance on a Tri-Met bus Mejia had boarded. He was then arrested for harassment and resisting arrest.

Mejia was eventually taken to Pacific Gateway Hospital, the state’s only private psychiatric ward. On Sunday evening, staff called police twice to help control and secure Mejia, who was reportedly threatening others.

During the second call, officers found Mejia outside a locked room they had initially placed him in. They used pepper spray and beanbag rounds to try and secure him again, but with little effect. One officer then fired the two fatal shots, police said. The three officers, placed on administrative leave, are not members of the bureau’s Crisis Intervention Team -  a unit of about 65 patrol officers who receive training every six months to deal with people who display signs of mental health problems. Hospital officials have yet to comment on the case.

Questions persist

Ramirez said the Mejia family “has been devastated of the unnecessary death.” Among the questions she raised:

• Why were police called by a Tri-Met driver over a difference in fare?
• How was Mejia treated by the officer who boarded the bus? Was the use of pepper spray and cuff restraints at the feet necessary?
• Was Mejia injured in his contact with the police?
• Was an interpreter contacted anytime in the chain of events?
• Why hadn’t the Mexican Consulate been contacted?
• What efforts were made to contact Mejia’s family after his arrest and once he was taken to the hospital?