Mental Health Association of Portland

From The Oregonian, July 29, 2010

Outside consultants shared with the Portland City Council Wednesday night the gaps and unasked questions in the police investigation of James P. Chasse Jr.’s death in custody, hours after the council approved a settlement of $1.6 million, the city’s largest, in a federal suit.

Police Chief Mike Reese apologized for Chasse’s death and said officers must do their jobs in a “more thoughtful and collaborative manner” with outside agencies. He called the three-year delay in the Police Bureau’s internal review “completely unacceptable.”

“We cannot change the outcome of what happened Sept. 17, 2006,” Reese said. “I’m very sorry for this tragic event and for the suffering that it caused.”

The chief said he agreed with the majority of the 27 recommendations offered by the California-based OIR Group and hoped they would help mend the rift between the bureau and the community.

Auditor LaVonne Griffin-Valade ordered that report. It recommended a range of reforms, among them requiring police to conduct face-to-face interviews with civilian witnesses and sending internal affairs investigators out to a scene immediately.

But the attorney who brought the wrongful-death lawsuit against the city for Chasse’s family said the consultants’ report got facts wrong and overlooked the bureau’s systemic failure to hold its officers and supervisors accountable.

Attorney Tom Steenson said the facts of the case were that officers who were involved in Chasse’s death changed their accounts of what occurred during the inquiry. They were not upfront with medical personnel about their use of force, they falsely suggested bread crumbs that Chasse dropped were cocaine when he had no drugs on him, and they lied to witnesses about Chasse’s past.

“There has been a consistent and repeated effort, conscious or otherwise, resulting in a failure to discipline officers,” Steenson said. “As a result, I believe they can act in impunity in the use of excessive force and can lie about it and attempt to cover it up.”

Other community members agreed, saying they were disappointed there’s been no serious accountability for the three officers who confronted Chasse. Officer Chris Humphreys and Sgt. Kyle Nice received two-week unpaid suspensions. Bret Burton, a Multnomah County sheriff’s deputy at the time, was not disciplined and has since been hired by Portland police.

Community members also disputed police suggestions that Chasse’s death marked a failure of the mental health system.

“In almost four years of review, no police officers were held accountable. No indictment, no crime, no personal accountability … ,” said Jason Renaud, a volunteer with the Mental Health Association of Portland who knew Chasse.

“Until you have the powers to act publicly and decisively in response to a critical incident, you cannot give assurance what happened to James Chasse will not happen again,” Renaud said. “What happened to James Chasse was not a failure of the system, of the institution, of the city. It was an unforgivable failure of three individual officers.”

Earlier Wednesday, city commissioners approved the $1.6 million settlement to Chasse’s family by a 4-0 vote. The agreement had been announced in May. Commissioner Dan Saltzman was not present. Mayor Sam Adams, ill at home with strep throat, voted by phone; he also participated by phone in Wednesday evening’s session.

On Sept. 17, 2006, police thought Chasse, 42, who had schizophrenia, might have urinated in the street in the Pearl District and tried to stop him. They chased him and knocked him to the ground, then wrestled with him to arrest him.

Multnomah County jail staff refused to book him because of his medical condition. He died in police custody en route to a hospital.

An autopsy found he died of broad-based blunt-force trauma to the chest. He suffered 26 breaks to 16 ribs, some of which punctured his left lung.

The consultants said the three-year pace of the internal investigation was a “letdown” to the community. They found Multnomah County refused to allow its employees to be interviewed by internal affairs investigators until after they were deposed in the civil suit. Also, AMR ambulance staff refused to speak to homicide detectives until they faced grand jury subpoenas.

The report indicated that command staff steered internal affairs investigators away from looking into allegations that officers at the scene misinformed a witness by falsely claiming Chasse had 14 drug convictions. Also, the inquiry never delved into the apparent lack of supervision of the officers by then-Transit Cmdr. Donna Henderson.

Derald Walker, chief executive officer of Cascadia Behavioral Healthcare, stunned observers when he told the council that Henderson is now on the agency’s board of directors.

“I’m sort of surprised the commander of Transit (then) is now on the board of Cascadia. There’s some irony there,” said Dan Handelman of Portland Copwatch.

Consultants also found investigators failed to question why officers carried Chasse in maximum restraints to a car, which exacerbated his injuries, and kept him there while they did paperwork across the street from jail before booking him.

Chasse’s family released a statement Wednesday, saying their decision to settle the case was not easy. However, they felt there was little to gain by going to trial, even though their lawyers advised them against the city’s final offer.

“We are relieved that the case has settled, but it is a very rough form of justice: the truth is that a civil suit seems to be the only form of justice that our local system will allow when police are involved in a killing,” their statement said.

They ended their statement with a tribute to Chasse, a “painfully shy” man who preferred comic books about superheroes over talking.

“James, may you rest in peace. We love you and miss you.”

From the Portland Business Journal, June 2010 – not available online

Under Derald Walker’s leadership, Cascadia Behavioral Healthcare quietly turned itself around.

Two years after a financial meltdown nearly destroyed Multnomah County’s safety net for the mentally ill, the nonprofit at the center of the crisis has rebounded.

Cascadia Behavioral Healthcare Inc. is a shadow of its former self, and will bear the burden of its April 2008 near collapse for many years. Even at half its former size, however, the Portland nonprofit remains a key component of the county’s safety net.

It returned to profitability in March. CEO Derald Walker, appointed in the midst of the crisis to turn Cascadia around, hopes to build a $500,000 cash reserve by early 2011.

Two years ago, these results seemed inconceivable.

Cascadia Behavioral Healthcare runs clinics for people struggling with addiction, offered counseling to people with severe mental illness and housed poor people with mental illnesses.

But in spring 2008, poor bookkeeping put all that at risk.

State Medicaid officials had ordered Cascadia to repay $2.7 million when the nonprofit could not provide documents backing previous years’ claims. Capital Pacific Bank had demanded repayment of a $2 million loan.

Leslie Ford, who had been CEO since Cascadia Behavioral Healthcare was founded through the 2002 merger of several smaller nonprofits, had been forced out. Two consecutive chief financial officers hired to turn Cascadia around had quit, after declaring the company’s books a mess and uncovering still more liabilities.

By summer 2008, it appeared as though Cascadia Behavioral Healthcare’s programs would be dismantled and farmed out to other nonprofits. Instead, the nonprofit is paying down its debt.

“They still have to watch their pennies,” said Kathy Tinkle, business services director for Multnomah County Human Services. “But they’ve made significant progress.”

Under Walker’s leadership, Cascadia obtained a $2.2 million loan from Multnomah County and the state. It negotiated its Medicaid assessment down to $1.2 million, payable over five years.

It also relinquished its role as Multnomah County’s pre-eminent mental health care provider by transferring several of its programs to other area nonprofits in order to cut expenses.

In August 2008, Lifeworks Northwest took over Cascadia’s Gresham clinic and Central City Concern took control of a downtown clinic at Southwest 12th and Stark streets. Luke-Dorf took control of Bridgeview, a residential treatment center.

Surrendering these programs cut Cascadia’s expenses, and the nonprofit cut costs still further by consolidating office space and leaving administrative jobs unfilled.

By drawing down the county-state loan, Cascadia invested in a $250,000 medical billing system aimed at further improving the nonprofit’s finances. The system prohibits Cascadia from submitting incomplete Medicaid claims, so that it can never again be reimbursed without adequate documentation, Walker said.

These cuts are paying off for the organization, but they have also left Cascadia much smaller.

It lost $2.1 million on revenues of $55.9 million in the year ending June 30, 2008, and lost $514,000 on revenues of $42.5 million the following year. Walker expects to end this fiscal year with a surplus of at least $200,000 from a budget of $38 million.

In 2008, Cascadia provided about 80 percent of Multnomah County’s mental health services. Now it provides only 32 percent of these services.

Meanwhile, county mental health officials have undergone their own transformation aimed at avoiding more surprises like the April 2008 Cascadia meltdown.

“We have realized that we can not be in a situation where we are so dependent on a single agency,” Tinkle said.

County mental health leaders now meet quarterly with their largest nonprofit contractors, and monthly with Cascadia, to track the performance health of the nonprofits that they fund.

Jason Renaud, volunteer and secretary of the board of the Mental Health Association of Portland, applauded Cascadia Behavioral Healthcare’s turnaround, and the county’s renewed oversight.

But he also lamented a mental health system that faces stagnant funding and growing demand.

Cascadia’s front-line workers, in particular, have borne a difficult burden through this transformation.

They have not received pay hikes since 2008. With a recent increase in the portion that many pay for health insurance, a number are now taking home less than they did two years ago. Walker also cut vacation days.

A new program that manages counselor productivity can allow some employees to boost take-home pay if they increase billings as a share of total hours worked. Though many workers have embraced the program, others grumble on the growing emphasis on money in a caring profession.

Since the nonprofit’s fiscal crisis, employees have had to accept paper checks because Cascadia does not have enough of a cash buffer to implement a direct deposit system.

But unlike the crisis of two years ago, these are challenges that observers expect Cascadia Behavioral Healthcare to survive.

“Unfortunately, any nonprofit with the county is in this boat,” Tinkle said. “Our dollars aren’t growing as fast as our personnel and expenses.”

LEARN – Cascadia Behavioral Healthcare
READ – Cascadia Behavioral Healthcare, Independent Auditor’s Report, June 30, 2009 AND 2008

Despite a recent warning in The Skanner, Derald Walker, CEO of Cascadia Behavioral Healthcare, thinks Portlanders can, and should, call 911 in crisis, if needed. It’s appropriate, Walker said, and can connect people with resources.

The Skanner’s warning came after the shooting death of Aaron Campbell on Jan. 29. Campbell was, according to The Oregonian, “an unarmed African American guilty of nothing except being suicidal and distraught.” Rev. Jesse Jackson called the death an “execution.”

Walker said he realizes that people have concerns and fears, which he called unfortunate, but, to some extent, understandable.

He added, “I think the Portland city police are trying to handle a lot of things on the streets that, quite frankly, if mental health services were more available, they probably wouldn’t be confronted with.”

Resources Needed

Walker believes that Portland police are trying to reduce the number of bad outcomes. The bureau has adopted crisis intervention training, which is now required for all officers.

But additional resources are needed, said Walker.

“We need more housing for people with mental illness, more after-hours service for people with mental illness – for everybody. And people aren’t always eligible for treatment. If you’re not on the Oregon Health Plan, you may not have access to mental health treatment; we need universal funding for mental health services. Funding is just not adequate at this point.”

Build Networks

Dan Handelman, of Portland Copwatch, said that police shootings are actually down in recent years.

Still, in the past five years, at least five people with mental illness, or in crisis, have been killed by Portland police:

Aaron Campbell, 2010
James Chasse, Jr., 2006
Jerry Goins, 2006
Tim Grant, 2006
Raymond Gwerder, 2005

Handelman points out that it’s difficult to pinpoint the exact number of cases, since mental illness is not always reported, and “crisis” is open to interpretation.

Asked whether people should call 911 in crisis, Handelman said ideally, people wouldn’t have to.

“In my opinion, people should build networks with family, friends, coworkers and neighbors so that, to the extent possible and reasonable, there is no need to call police. I also believe that a person should be able to call 911 and explain they have a mental health crisis situation and that should be able to be resolved without an armed police presence.

“People need to make up their own minds about what to do, but certainly given the possible outcomes I hope that more community building and less reliance on armed intervention is in this city’s future.”

From the Portland Tribune, September 17 2009

Interesting, how one building can mean so many different things to so many people.

Cascadia Behavioral Healthcare reopened its Garlington Center on North Martin Luther King Boulevard Friday amid a great deal of rejoicing. A ribbon was cut, speeches were made by notables, including an ex-mayor and a variety of leaders in the Portland black community. But not everyone present was celebrating the same thing.

Derald Walker was celebrating financial progress and also the way a disaster opened room for new community connections. Cascadia’s chief executive officer, Walker came to the nonprofit in 2008, shortly after the financial meltdown that very nearly closed Multnomah County’s largest provider of mental health services. It took a $2.5 million state and county line of credit to save Cascadia.


But the Garlington’s Center’s particular disaster was near total destruction from a fire in October 2008. The fire’s cause has not yet been determined, but many members of the Garlington community are convinced an arsonist was involved.


Walker said it cost $2.2 million to rebuild Garlington, nearly all of it covered by the building’s insurance policy. Of more concern is the ongoing operating cost for the center, an estimated $1.3 million.


Walker didn’t say keeping Garlington open on a sustainable basis will be easy, not with Cascadia still paying off $2.3 million worth of loans.


“Running publicly funded health care is not for the faint of heart,” he said. But on Friday, at least, Walker said the future for Cascadia looked brighter.

“We survived last year and we’ve come out a lot stronger,” he said. “I think we’ll be fine.”

New clinic space

The new Garlington Center represents substance for Jill Ginsburg, and relief. A family physician who started the North by Northeast Community Health Center three year ago in a tiny building on North Williams Avenue, Ginsburg has watched her free clinic patients line up outside on Thursday evenings, and sometimes wait in their cars.

Some of those people who had come to North by Northeast for the only health care available to them had to be turned away, sent to other safety net clinics. Ginsburg simply had no room.

Ginsburg has room now, at the Garlington Center. Her new clinic space is four times the size of the old, with four treatment rooms instead of two, a waiting area that can seat 20, and even a break room for volunteers.

Was there some sort of break room in the old North by Northeast clinic?

“Are you kidding?” Ginsburg asks. “We had a treatment area in a hallway behind the curtain. We’re growing up and (Garlington Center) is a beautiful place for our patients.”

Youth resource center

Proud as she has been of the Sexual and Gender Minority Youth Resource Center for which she serves as program director, Favor Ellis has recognized the center has not been as diverse as its name implies.

The Cascadia-financed center, based in Southeast Portland for 11 years, has been the only organization in Portland with the aim of providing a supportive environment for lesbian, gay, bisexual and transgender youths.

But nearly all those youths were white.

And that is the primary reason the center has moved its offices and hangout space into the new Garlington Center.

“Queer identified African American youth in Northeast Portland may have felt like SMYRC was a resource for white youth,” Ellis said, adding that non-heterosexual black youths may not have felt welcome in Southeast Portland. “It may have been scary for them,” she said.

In the new Garlington Center building, the minority youth resource center may truly be able to bring in minority youths, Ellis said. Outreach has begun to predominately black organizations and churches in North and Northeast Portland. The message, Ellis said, is that gays, lesbian and transgender youths of all races are at increased risk for suicide, drugs, alcoholism, teen pregnancy and as victims of violence.
Reopening is a tribute

Maggielean President also attended Friday’s opening ceremony at the Garlington Center. President, a Northeast Portland resident who has been a Cascadia client since 1999, attends group therapy twice a week, so she’s happy to have Garlington back. But the real significance of the reopening for President was what she calls “paying tribute.”

Garlington Center is named after John Garlington, a black minister and social activist who died in a car accident 13 years ago. Reopening the center keeps Garlington’s memory alive, according to President.

“Whoever did this did us a favor by setting this place on fire,” President said. “The favor is that this place is looking better that it was at first.”

More triumphs

Nobody understands the daily struggle to overcome life’s obstacles better than those who suffer prolonged mental illness. Ryan Hamit took the fire personally.

“I’ve seen programs come, stay a while and go. I’ve seen staff leave. I’ve seen a lot,” said Ryan Hamit, who lives in the Pearl District but for years has received a variety of mental health services at Garlington, nearly an hour away by public transit. Hamit serves on the Garlington consumer council, which lobbied county officials to save Garlington during Cascadia’s financial crisis.

“It’s like an extended family to me,” Hamit said, explaining why he travels cross-town.

The fire, to Hamit, was another obstacle in a series of obstacles faced by Garlington and the people who need its services.

“It’s hard when there’s always somebody out there trying to cut us down,” he said.

For Hamit, last Friday’s reopening was just one more in a long line of triumphs.

From the Oregonian, April 15 2009

Ralph A. Williams is still on the docket to appear in Multnomah County Circuit Court today to respond to his neighbor’s request for a permanent stalking order against him.

Instead, Williams, 54, faces murder charges, and his neighbor, Sean Liam Kelly, 40, lies in the morgue, dead of stab wounds and crushing blows to the head.

Kelly had been begging for help for at least the past month from Cascadia Behavioral Healthcare housing officials, police and the courts, citing his neighbor’s increasing threats of violence against him, court records show.

He had hoped a judge would sign a permanent order today against Williams, who lived next door to him in an independent housing building for the mentally ill on North Chase Avenue.

Stalking orders between residents living side by side in public housing complexes aren’t uncommon. Judges can’t order people to move, making such orders a challenge. Judges say they must be creative to give the person seeking an order some sense of security and make sure they have a safety plan in place.

“It’s one of the most difficult things that we face,” Multnomah County Circuit Judge Cheryl Albrecht said. “In stalking orders, there’s just no ability to force someone to move from their residence. It’s not an effective remedy. It’s just not. You just hold your breath and try to be as direct and clear with the respondent about the scope of your order. It’s perilous at best.”

Kelly obtained a temporary stalking protective order against Williams last month, detailing ongoing harassment, intimidation, racial slurs and vandalism he endured from Williams.

Kelly, who was on unemployment and attending classes at Portland Community College’s Rock Creek campus, called police twice last month and documented the abuse, threats, property damage and growing tensions between him and Williams in back-and-forth e-mails to Cascadia Housing property manager Deborah Hicks.

In early March, Kelly said Williams poured six gallons of water into the gas tank of his car and then became aggressive and called Kelly a “snitch” after he reported the vandalism to police. He said Williams stuck his hand in his face, threatened to harm him, and banged on his apartment door while spewing profanity and racial slurs, according to the stalking order application.

“I was clearly not safe in my own house, and I began to be afraid of leaving my room,” Kelly wrote, noting Williams, at 6-foot-5 and more than 200 pounds, was much larger. Kelly was 5-foot-11 and weighed 160 pounds.

Cascadia had recommended mediation between the two men and urged Kelly “to stay clear” of Williams, although that was next to impossible because Williams lived in the neighboring unit and they shared a kitchen. Cascadia also recommended Kelly contact the courts or police and mailed Williams an eviction notice March 13, listing Kelly’s well-documented run-ins with Williams.

“I understand that you are fearful, and I would be too,” Hicks e-mailed Kelly on March 16. “I hope he doesn’t do anything to harm you, but you are totally within your rights to do whatever legally you can. … You want to do whatever you can to protect yourself while we wait this out.”

Cascadia does not staff the housing complex with a case manager, and the property manager is not on site.

Jim Hlava, Cascadia’s vice president for housing, said he could not talk about specifics but said the case would be reviewed internally.

Applicants must be assessed as “ready and capable” to live on their own, Hlava said. Cascadia also does a criminal background check and reviews the person’s documentation of income and disability.

Kelly moved to the North Chase Avenue unit early this year. It’s not clear how long Williams lived at the site. Williams also faced an unrelated domestic violence restraining order filed against him in March 2008, after he knocked a woman unconscious and stomped on her head, court records show.

Christy Brewfaugh, a close friend of Kelly’s mother, questioned why Williams was allowed to live in the building, considering his violent past.

Hlava said that when tenants don’t get along, Cascadia gives them options, whether it’s mediation or calls to police if there’s vandalism or violence.

“We take appropriate landlord action with the information that is given to us,” Hlava said. “We work within the landlord-tenant law.”

The court granted Kelly a temporary stalking protective order March 18. The next day, a Multnomah County sheriff’s deputy served the notice in person to Williams. It ordered Williams not to come into “visual or physical presence” of Kelly, speak with him or damage his property.

Just before 7 a.m. Tuesday, a 9-1-1 call came to Portland police, reporting an assault at the North Chase Avenue address. When police arrived, Williams was outside the building, and said, “Arrest me. … I stabbed him with a butcher knife.”

According to Williams, Kelly had come into the common kitchen area of the building, told Williams to get out of his way, and went back to his apartment. Williams told police he had “had enough” of Kelly, grabbed a butcher knife and waited for Kelly to return.

Once he returned, Williams told police, he “let the knife do the talking.”

He said he stabbed Kelly five to seven times in the upper chest and head. As Kelly tried to run across the street, Williams tried to stab him in the back, a probable cause affidavit says.

When the knife blade broke, Williams picked up a cinder block and struck Kelly in the face as he lay dying on the front yard of a neighbor’s home.

READ – Suspect identified in deadly stabbing outside N. Portland halfway house, KGW.com
READ – Man Stabbed To Death In North Portland – Body Found Outside Group Home, KPTV.com
READ – Sean Kelly’s stalking order petition and correspondence with Cascadia staff staff about threats from Ralph Williams
READ – N. Portland deadly stabbing suspect confesses in court, KGW.com

A little more than a year has passed since State and County officials began to worry about the state of affairs with Oregon’s largest private provider of mental health services – Cascadia Behavioral Healthcare.

After a series of newspaper articles which questioned the financial state of the nonprofit after a Medicaid audit were met with reassurances of stability, Leslie Ford, then CEO, President and founder of Cascadia abruptly resigned in April. She was followed by all of her longtime senior staff members. Finding a substantial and unpredicted shortfall in revenue left behind, the Cascadia appealed for assistance from Multnomah County. Their appeal resulted in several infusions of cash, and county officials insisting Cascadia do it’s business differently.

Clients of Cascadia were in real jeopardy for a short duration of time. Without intervention from the county and state, vital and irreplaceable services could have vanished. Big changes have occurred, administrative, financial, clinical.

The Mental Health Association of Portland has asked Cascadia Behavioral Healthcare to answer some basic questions about changes at Cascadia, general and specific. They’ve agreed, and over the next few weeks we’ll post this virtual dialogue on this web site.

You’re welcome to join in and both ask your own questions and comment on the answers given by leaving a comment below. Send your questions to info@mentalhealthportland.org.

Question for Derald Walker, Ph.d, CEO and President of Cascadia Behavioral Healthcare.

Can you tell us what Cascadia is today, and give us a basic understanding of how Cascadia transformed over the past year?

Cascadia Behavioral Healthcare is much more financially stable. The changes that have led to a more stable organization are due to a variety of cost cutting moves that included painful but necessary staff reductions. The large majority of the staff reductions were administrative in nature. Cascadia continues to focus on eliminating costs where possible without impacting consumer services. We’ve completed the implementation of our new automated billing system as well as a fully integrated accounting software program. The combination of cost reductions and improved revenue and accounting systems have helped significantly.

Cascadia no longer operates clinics in Gresham and Downtown Portland. The contracts in these two locations and in Washington County were transferred to other community providers. In addition to these changes, Cascadia’s Bridgeview program was also transferred.

While these changes have reduced Cascadia’s scope, we continue to provide an impressive continuum of services that comprises a valuable system of care for our community. Some of these services are residential, community clinic services, mobile crisis outreach, integrated services between addiction and mental health as well as specialty affordable housing services.

Given the uncertainly with publicly funded healthcare, Cascadia’s financial future will continue to provide challenges. However, with the improved internal information systems that include claims, clinical productivity, and financial accounting, our ability to anticipate and adjust in ways that will protect consumer care is greatly enhanced.

EXTRA – Cascadia Behavioral Healthcare

From the Portland Observer, December 2008


In the early 90s, Ryan Hamit had a “bad spell” and ended up in a hospital struggling with a personality disorder. He bounced from various social service agencies and hospitals, encountering counselors that talked down to him and seemed to make problems worse.

Things got better when he started using the Garlington Center, a longtime local mental health provider with multicultural roots, currently operated by Cascadia Behavioral Healthcare.

At Garlington, he found himself better respected by the staff and not talked to as if he was a confused child, like he had at other places. Hamit started to improve.

“I wouldn’t be near as well off if it wasn’t for the Garlington Center,” said Hamit.

But over the past year, Garlington has had its own bad spell. It almost collapsed financially when Cascadia fell into financial turmoil. Then the center had a devastating fire.

Named after the late Rev. John Garlington, an African-American minister who worked closely with the poor, the Garlington Center is one of the most culturally sensitive providers of mental health and substance abuse services in the area. It also connects people with stable housing and jobs.

“These are the folks, where if they don’t have these services, they’re going to be downtown costing the community a lot more money,” said Jim Hlava, Cascadia’s vice president of housing.

Essie Mae Morphis, an African-American client of the center for about 10 years, explained how Garlington has provided her with care that has no parallel in its cultural tactfulness.

“If I couldn’t get my meds I’d be somewhere in a state hospital,” said Morphis of the value she places on Garlington services.

Cascadia’s chief executive officer Derald Walker explained that the center helps people through group therapy, helping them develop a sense of stability, and assisting them in managing their own medication regimen.

Statewide, Cascadia has an operating budget of about $42 million, which comes from a patchwork of state, county, and federal funds, according to Walker. It services about 525 people, he added.

Last summer, the non-profit nearly collapsed financially due to mismanagement. According to reports on Multnomah County’s website, Cascadia was hemorrhaging money due to a faulty billing system (among other problems) that essentially didn’t charge the appropriate sources for services.

In April of this year, Cascadia informed the county that it was on the verge of defaulting on a $2 million line of credit from Capitol Pacific Bank, and was about to go under. The Garlington Center would have expired had it not been for a loud chorus of voices that rose in protest.

Gascadia was saved by a $2.5 million loan comprised of state and county funds. A nationally recognized consulting fire was called in to correct the problems with billing, among others.

According to Walker, Cascadia has implemented many of the firm’s suggestions and is steadily recovering.

“We’re cautiously optimistic,” said David Austin, spokesman for the county’s department of human services, which has worked closely with the Cascadia on its financials. He added that the mental health provider continues to provide an essential service to Portland.

Austin said that Cascadia is taking recommendations from the county and the consulting firm seriously, and appears to be stabilizing. He also pointed out that Cascadia has passed along two of its other clinics to other non-profits, which has been a huge financial relief.

The fire sparked last October in the Garlington Center’s Martin Luther King Jr. Boulevard location extensively damaged the building, a former NIKE factory outlet.

Currently, the center looks as if it’s the aftermath of a war. Its windows are boarded up. Yellow tape lines scorched walls and corridors. The sharp, sour smell of the smoke has marinated the air, and still lingers heavily. The floor of some rooms is pitch black and sprinkled with broken glass.

Since the fire, clients have had to go out of her way to an alternate Cascadia center on Southeast Division Street and 43rd Avenue.

“It’s a hassle,” said Morphis of having to make the trek to the alternate center.

The clinic’s director Tasha Wheatt-Delancy expects to have the MLK facility back up in about six months. Currently there are several trailers outside the building where clients will be served. They are not quite ready, said Wheatt-Delancy. But she’s hoping they’ll be ready soon.

Hlava isn’t sure how much the building repairs will cost.

The fire is considered “suspicious,” and is under investigation by local and federal investigators.

Walker said that Cascadia is taking great care not to allow the tumult facing the organization to interrupt services facing clients.

However, Cascadia’s problems aren’t entirely in the past. Walker said that the state budget cuts could affect the non-profit’s addiction treatment program, but isn’t entirely sure what could happen.

“Making sure we have stable funding is our biggest challenge,” said Walker.

From the Oregonian, October 21 2008

More than 500 mental-health patients will have to go elsewhere for service after a fire destroyed part of a Cascadia Behavioral Healthcare clinic in Northeast Portland last night.

No one was injured by the blaze at Cascadia’s Garlington Center on Northeast Martin Luther King Jr. Blvd., but authorities say it appears to have “suspicious” origins. The cause of the fire that officials say began sometime before 9:52 p.m. is under investigation.

“It’s very important that we get it back up and running,” said Cascadia chief executive Derald Walker. “A lot of the people we serve live in this general area.”

An outcry of public support helped keep the center’s doors open after it nearly shut down this year in the face of severe financial problems at Cascadia.

The center had staff on hand today to help people who showed up for services, and telephoned other patients sending them to Cascadia Plaza about four miles away, Walker said. The Garlington Center served 525 clients, he said.

When the center will again be able to serve patients is unknown. Walker said officials today were still assessing the extent of the damage.

Fire officials estimate $200,000 worth of damage to the structure and an additional $400,000 to the building’s contents.

Walker said that as much as one-third of the building was badly burned, and that smoke damaged other areas. The fire destroyed Cascadia’s main computer, housed at the Garlington Center, but Walker said patient records weren’t lost because the hard copies survived. With the server destroyed, Cascadia cannot use its electronic medical records system and automated billing system until the arrival of a replacement that Walker expected by the week’s end.

The clerical area received the brunt of the damage, Walker said, with computers, copy machines and other business equipment burned in the flames.

“We will take precautions to make sure anyone connected to the Garlington Center who needs services will have a way to get them until it can be repaired,” Multnomah County Board Chairman Ted Wheeler said in a statement. “Given the economic crisis, these are anxious times for everyone. We will make every effort to make sure clients don’t fall through the cracks. Services will not be interrupted.”

EXTRA – NE Portland mental health center fire called ’suspicious’, from KGW.com

TO All staff; Board of Directors
FROM Derald Walker, Chief Executive Officer
DATE July 10, 2008
SUBJECT Latest news

I have heard from many of you in response to the Oregonian article. I appreciate all the questions, concerns and frustrations you are experiencing. I will focus today on the one point that is likely the biggest question on your mind from the article which is… will Cascadia remain open after July

Despite what you are reading and hearing, I believe – and have support from our community partners – that the answer is yes, as long as we implement the changes and the downsizing that I have outlined in previous communications; and as long as we redouble our efforts to increase our revenue in our fee for service programs.

Despite what you are reading and hearing, payday is coming up and paychecks will be distributed according to our standard process. Our efforts in the next several weeks are critical to our survival, and I need and appreciate your continuing help in this.

I am very concerned about the serious downturn in our clinical productivity data. I realize this can be attributed to a number of recent factors, but despite this difficult time, we MUST increase our productivity immediately. The recent reopening of our Mental Health intakes will help, but what is really needed is a concerted effort on your part to manage your clinical schedules to their fullest capacity.

In addition our senior leadership and directors have been working to transition and close programs over the past month. Washington County, Bridgeview, TAY, MIOS, and TNP have all been completed. We have to continue with our downsizing as swiftly as possible.

Lifeworks continues to be in negotiation with regard to transitioning the Gresham building, consumers, and any staff who apply for and are offered positions with the new provider.

Final decisions for the Garlington building and programs will be made very soon.

Negotiations continue in Marion County for possible transfer of services.

In addition to clinical program changes, reductions in our workforce will also be felt in our administrative services as we will require less support for our programs as we get smaller.

The HR team is very actively working with Directors to redesign our employee benefits package as a way to effect cost savings. Please note that there is no plan to reduce our health insurance coverage benefit, although we are looking at a number of other ways to reduce costs while supporting our workforce.

Our residential programs that have specific contracts which outline and require certain staff numbers (including PSRB, ECMU, RITS and Turning Point) will likely not change much, aside from the changes that affect the whole agency. The same can be said for other services, including money management, and all services at Plaza and at Woodland Park.

Finally, you may already know that Chip Burczak, our Chief Financial Officer is leaving the company. I have confidence in the financial infrastructure that he has so ably built, and know that the team of talented people he has helped to assemble are up to the task of moving on to the next steps. Please see the attached news release for more on this.

In previous Executive Updates I’ve sent to you I’ve consistently tried to represent my strong sense of hope, and recent developments may present a contradiction for you. These past months have been confusing and at times disappointing for me as well.

Yet, even at some of our most discouraging moments, I’ve remained determined that Cascadia will recover from this crisis and reach a time of stability. I remain very positive today. The outpouring of support I continue to receive from many key Oregon stakeholders and organizations has only increased over time. This includes many gestures today.

As I’ve said before, I admire every member of our workforce, and our consumers and friends in the community, who continue to hang in there with us. This represents a powerful force in insuring continuity of services for consumers of community mental health in Oregon.

TO Oregon news media, interested community members
FROM Derald Walker, Chief Executive Officer
DATE July 9, 2008
RE Financial leadership at Cascadia in transition

Cascadia Behavioral Healthcare Chief Executive Officer Derald Walker, Ph.D., today announced a transition of financial leadership within the company, preparing Cascadia to take the next steps in becoming a leaner, stronger nonprofit corporation.

Chief Financial Officer Chip Burczak is set to leave Cascadia on July 22. Walker and Burczak will work with other senior management until then to effect a smooth transition. Multiple financial accounting systems that had previously been working separately are now fully integrated. New talent and systems within the Accounting Department are working at high performance. Given the strength of the current accounting infrastructure that Burczak has created in his four months with the company Walker is in a position to thoughtfully recruit a new CFO.

Walker is arranging to supplement financial operations in the Accounting Department by temporarily bringing in new team members while the transition is being effected.

The Executive Committee of the Board of Directors met this morning to review and finalize plans for the transition of Cascadia’s financial operations. The Board is actively involved in advising on next steps.

Following a conversation with Multnomah County leadership this morning Walker reported the continuing support of the County going forward as Cascadia and the County effect improvements in the local system of community mental health. In cooperation with the County, Cascadia has made significant progress in transitioning services and in achieving financial stability.

From the Oregonian, July 2, 2008 – opinion column by Renee Mitchell

The truth was clearly spoken.

But it might have sounded so familiar that most of the 100 or so folks who attended Monday’s rally to support Northeast Portland’s Garlington Center may have missed it.

Let me recap.

But first, I’ll sprinkle some history on the truth to make it more palatable for those who don’t understand the emotionally charged fuss.

The Garlington Center is the only mental health clinic run by Cascadia Behavioral Healthcare that is on track to be shut down. Its nearly 600 clients would be shoved onto the overloaded caseloads of other mental health programs in the city.

“That is unacceptable,” stated Sen. Avel Gordly, one of the state’s most effective and outspoken champions for the mentally challenged.

So how did we get here, then?

The question was asked so many times Monday that the truth finally spilled from the mouth of Derald Walker, a clinical psychologist who took over Cascadia in April. The Garlington Center’s largely minority, low-income, mentally ill clients, he said, “are not the highest priority.”

That’s why Walker, under pressure from Multnomah County, which is under the state’s thumb to quickly mitigate Cascadia’s financial problems, says he chose the path of least resistance. Who would care?

Monday, he realized he was wrong. The center is the only place in the county where uninsured clients of color also receive help with housing and jobs and access to a culturally familiar staff.

“I got some time clean because of an agency like this,” said Nabeeh Mustafa, who has been clean for 16 years after spending three decades in and out of prison for crimes to support his drug habit. He worked in an intensive case management program for addicts and alcoholics until Cascadia’s Treatment Not Punishment closed this week. “We all got some mental health problems.”

Closing the center makes county leaders gutless hypocrites. County Chairman Ted Wheeler heads the county’s year-old Health Equity Initiative, which, according to its Web site, “works to address the root causes of socioeconomic and racial injustices that lead to health disparities.”

He should already know that various displacements — from the Vanport flood to the Memorial Coliseum to a series of other past and current urban-renewal projects — have all disproportionately squeezed blacks out of a neighborhood that once created a sense of place in a mostly white city.

As a result, the black and other minority communities continue to suffer mightily from poverty, health disparities and other environmental stresses, which can exacerbate mental health issues, which, uncontrolled, can spill into homelessness, addiction, violence and crime.

But the Garlington Center has proven to be an important reservoir of hope and self-help models for those drowning in despair. Keep the center open, Gordly pleaded, “so we don’t have any more of the pain.”

Monday, with Gordly’s gentle prodding, Walker acknowledged he made a mistake by suggesting the center’s closure. He stated, emphatically: “We would be willing to take Garlington off the list.”

With Gordly’s insistence, Joanne Fuller, county human services director, also admitted her own negligence in allowing the issue to get this far. She, too, should have known better. But, at this point, correcting the mistake would need permission from Wheeler and Jim Scherzinger, of the Department of Human Services.

Fuller added this directive: “Keep telling us what you want.”

In other words: Wheeler needs to be held accountable to do what he promised: serve those at highest risk. Silence has no place when justice cries for our attention. So when truth hurts, say “ouch.” Loud and proud.

Officials hear plenty from a crowd of 100 who want the Garlington Center to stay open

from the Oregonian, July 1, 2008

Northeast Portland’s Garlington Center, a community cornerstone that serves nearly 600 people with mental illnesses, may avert closure thanks to pressure from a standing-room-only crowd Monday.

The clinic at 3034 N.E. Martin Luther King Jr. Blvd. faces shutdown because of the financial problems of its operator, Cascadia Behavioral Healthcare. The clinic serves mostly neighborhood residents, including many African Americans and other minorities.

Multnomah County, which runs the mental health system, is downsizing Cascadia. Derald Walker, chief executive officer of the nonprofit company, suggested closing the Garlington Center because he thought its clients could get help from clinics elsewhere.

The county accepted this and other suggestions as part of its reorganization of the mental health system. But the collective message from Garlington clients Monday: Don’t do it.

“That I am even here is a testament to Cascadia,” said Adit Hughes, who explained that she has agoraphobia — a fear of being in public places. How could she and other clients be farmed out to other counselors and maintain their fragile stability? she said.

“It’s not just for my stability, it’s for my family’s stability,” said Hughes, who has three children.

Ralph Williams talked about what it’s meant to have a center with a largely African American staff that understands him.

“It’s been a long time since I smoked crack and got in trouble,” Williams said. “This place has been very instrumental in helping me stay focused and on track.”

Ryan Hamit, president of the Garlington client council, and other council members kicked off the 21/2-hour town hall-style meeting with Cascadia’s Walker and the county’s top mental health officials. More than 100 people attended.

Hamit handed Walker a folder of signatures on a petition to keep Garlington open. “It goes on for 40 pages,” he said.

Clients demanded more involvement in decisions. They pushed officials on why they had targeted Garlington. They emphasized that other mental health providers in Northeast Portland are not equipped to absorb all of Garlington’s clients and that the expense of a transition would be better spent to keep Garlington open.

Joanne Fuller, county human services director, said the county had to move quickly in light of Cascadia’s financial crisis and had been unable to get sufficient input from clients. This past spring, the county and state came through with a $2.5 million bailout for Cascadia after a bank called in the company’s loan.

Fuller said the county is committed to serving North and Northeast residents in their community, but must figure out whether Cascadia can continue to be the service provider.

The Garlington situation is complicated because Cascadia is buying the center’s building. If Cascadia were no longer providing the services, clients probably would move to other providers at other locations.

Cascadia’s Walker said that his company wants to keep Garlington open and provide some level of services but must, in partnership with the county, figure out what is viable.

State Sen. Avel Gordly, an independent from Portland, whose district covers parts of Northeast and Southeast Portland, stood several times and pressed officials to commit to keeping Garlington fully operational. Near the meeting’s end, she walked to the front, put her hand on Walker’s arm and looked him in the eyes.

She asked him to acknowledge what he had said to her in a private meeting: that he had not tried to think of a way to keep Garlington viable and had made a mistake in assuming other clinics could care for its clients.

“That’s right,” Walker said.

Then she put her hand on Fuller’s back and asked her to acknowledge that the county should have pushed back on the idea of closing Garlington. Fuller acknowledged that.

“We can’t have any more pain,” Gordly said. “We can work this out.”

“Absolutely,” Walker said.

Fuller said she couldn’t promise that Cascadia could continue to provide the same services at the center, but that she is now committed to looking into how that might be possible.

“We absolutely have to push back,” she said, “and figure out — can we find another solution?”

EXTRA – read how closing the Garlington Center caused an avalanche which collapsed Portland’s mental health system in 1999 in Diane Ponder et al v Employment Department & Garlington Center.

TO All staff
FROM Derald Walker, Chief Executive Officer of Cascadia Behavioral Healthcare
DATE June 27, 2008
SUBJECT Latest news

I’m writing to summarize what’s going on, including the departure of many Cascadia employees. (Please see the note on this below.)

I hope you trust that I clearly understand how difficult this for all of us, and for our consumers and their families. Thank you for your efforts in maintaining the continuity and quality of care that our consumers need and deserve. The stories I hear from the field, from employees and from consumers and families, are a continuing source of inspiration.

For today the best I can do is to attempt to keep you up to date, and let you know what I know and what I do not know. Please advise if you notice any details that are missing or in need of correction.

This is what I know:

· Gresham and Garlington remain on Multnomah County’s plan for transfer, but the timelines and the names of the replacement providers are still being discussed between the County and potential providers. Nothing is yet settled.
· We continue to work with Marion County. No decisions have been made.
· Due to a better understanding of what services Cascadia will offer in the future, and where, new client intake has resumed. Cascadia now accepts new clients as follows:
· We accept new MH child and adult counseling clients at our Woodland Park site.
· We accept new MH adult psychiatric clients at our Downtown site.
· We accept new MH adult psychiatric clients at our Plaza site.
· We accept new MH clients at our Gresham or Garlington sites on a case by case basis.
· We continue to receive broad support for maintaining our housing system.
· A & D and other intakes have never changed and remain open to new intakes.
· The plan is to transfer one Multnomah County ACT team to Central City Concern, although final arrangements between Multnomah County and CCC are still being discussed. The timing is not yet set.
· The programs at the Beaverton and Hillsboro Centers, TAY, MIOS, TNP, House of Umoja, and Bridgeview are scheduled to transition to other providers in the next few days.
· Members of the Cascadia Consumer/Survivors Advisory Council will host an open public conversation next week at the Garlington Center, sponsored by the Northwest Health Foundation, to discuss the future of local community-based behavioral health. Contact Della at Garlington for details (dellaf@cascadiabhc.org). I’ve heard of some interest in having a similar event, focused on the issues specifically impacting Gresham/East Multnomah County. Nothing is yet planned, but if this interests you please advise our Director of Consumer & Family Involvement, Sharon Gary-Smith (sharong@cascadiabhc.org); or ask consumers or family members to contact her.
· Cascadia Senior leadership (Chip, Enrique, Barb and me) are holding twice-weekly meetings with NAMI, other consumer advocates, and Multnomah County for the purpose of coordinating efforts to transfer contracts in a way that supports the best interests of consumers, the community, and employees.
· We are honoring our Memorandum of Understanding with Multnomah County, and our partnership with the county that the agreement represents, yet we remain flexible and open to continuing any contracts, if that would be in the best interest of the consumers and the community; and if in so doing, such changes would be advisable for Cascadia’s financial health.

Beyond all this there are few issues that are unsettled and that need attention in the coming days and weeks.

This is what I do not know:

· The final plans for paying back the loan from Multnomah County and State.
· The details of the planned transfer of Gresham and Garlington clinics. We do not know the timeline or the replacement providers.

All in all, as difficult as this is, I see that we are making incremental progress in some areas, but the complexity of the situation and the ever changing nature of this process makes it difficult to provide accurate predictions on the timing and ultimate outcome on just about all fronts.

Finally, I want to note that with the closure of our Beaverton and Hillsboro Centers, TAY, MIOS, TNP, House of Umoja, and Bridgeview, and with some resignations across our multi-county enterprise, some wonderful people are leaving Cascadia. I wish you all the very best in the future and thank you for your dedicated service. Also, I hear that many employees have elected to not leave the company and have taken new positions in other Cascadia programs. I also wish the best to you, and find some comfort in knowing that the talent and compassion you all hold will remain in the community.

+ + + +

TO All staff
FROM Derald Walker, Chief Executive Officer of Cascadia Behavioral Healthcare
DATE June 27, 2008 – later in the day
SUBJECT Latest news – supplement

In my recent update I asked you to advise me if there were any details missing or in need of correction. Thank you for doing just that.

I’ve heard from people involved in our residential sites that I failed to mention these essential services in my update. This was an error and I apologize for the oversight. The following item should have appeared in the list of the things I know:

Residential services at Bridgeview are scheduled to be transferred to Luke Dorf as of July 7. Other than this change, our portfolio of residential services will remain as it is.

from The Oregonian, June 25 2008

Some 900 clients are getting new care providers because of Cascadia Behavioral Healthcare’s financial meltdown, a difficult process

Multnomah County’s plan to move more than 900 mental health care users from financially troubled Cascadia Behavioral Healthcare to new providers carries serious medical risks.

Oregon’s biggest mental health provider, Cascadia is financially overextended, losing about $400,000 a month and risking bankruptcy unless it can cut staff and increase efficiency, county officials say. To stabilize Cascadia and ease problems if the nonprofit collapses, they say, they must move clients.

But changing clinics or counselors can damage people’s hard-won progress. Avoiding breaks in care is vital for people with schizophrenia, multiple psychiatric diagnoses or poorly controlled depression. It often takes years to find the right medicines, counselors and routines that can help them live and thrive independently.

“Folks who have conditions like this adapt very poorly to changes in the system of care,” said Dr. George Keepers, chairman of the Psychiatry Department at Oregon Health & Science University. “This stuff is not good for people.”

At any time, Cascadia helps 6,000 Multnomah County residents deal with issues from addiction recovery to psychotic crises. Many should move to a new provider without a hiccup.

But for some, especially the most vulnerable, as little as a week without medication or a few missed appointments could spur a big setback — in the worst case, a psychotic episode. That could mean more hospitalizations, more people slipping into homelessness and other problems rippling out into the community.

“If that goes badly, and it often does, people can free-fall in terms of level of functioning,” said Derald Walker, the clinical psychologist who took over Cascadia in April.

Mental illness is so complex and individual it’s hard to pinpoint who might have setbacks, Walker said. But he recalled a Clark County woman whose case showed the dangers of off-and-on medical care.

Walker met the woman when, as a college freshman, she withdrew from friends, grew emotionally explosive and began hearing voices. He diagnosed her first schizophrenic break and had her hospitalized involuntarily. Tranquilizers and antipsychotic pills helped the young woman improve enough to move home. But she didn’t understand she was ill, didn’t like the drug side effects and didn’t want to live with her parents again. She secretly quit taking her medication and started sneaking out at night. This led to a cycle of hospitalizations, homecomings and returns to the street, which slowly made the woman sicker.

“She was pretty much always psychotic” after five years, Walker said. “She got pregnant by a transient and started doing street drugs. The last time I heard of her, I think she got HIV. It was in the ’80s. She could very well be dead by now.”

It’s not unusual for uncontrolled mental health problems to spill into homelessness, addiction, poverty or other physical health problems — all risks of a health care interruption. Because of such concerns, Keepers said, “the average life span of somebody with a serious mental illness is dramatically shorter than someone in the general population.” In some cases, patients’ only access to health services is through their mental health providers.

Even if care isn’t interrupted, getting a new provider can pose problems.

“Once you’ve established that you’ll be a caregiver to somebody who has some dependency on you, if you break that trust, it’s the worst thing that can happen,” said Patricia Backlar, a Portland State University bioethicist who is on the county’s Adult Mental Health and Substance Abuse Advisory Council.

Backlar, who wrote “The Family Face of Schizophrenia” and has a son with the illness, said society has an obligation to help “people who on occasion can’t necessarily care for themselves,” and see that care through. With severe mental illness, she said, “to thrive, you really do need some continuity of caregiving.”

If detailed medical notes don’t move with the patient, for instance, a new caregiver may try therapies or drugs that already have failed.

And changes force patients to find the time, trust and emotional strength to start a tough process again.

“It’s hard to tell your story and have people set up a plan, say, ‘We’re going to do this,’ and then three months later start over again,” said D-Borah Forrest, who gets care for anxiety, insomnia and post-traumatic stress disorder at Cascadia. “I figure, why bother? It just becomes too overwhelming.”

Forrest’s counselor took another job last week. But she feels lucky: The county’s plan lets Cascadia keep the Southeast Portland clinic where Forrest goes, and one of her group-class leaders will take over as her counselor.

But she worries about other Cascadia users, especially in areas where another company is taking over.

“It’s hard for a lot of us to change where we have to be and when we have to be there,” she said. “If we don’t have that structure, the disease gets worse. . . . We start kind of wandering.”

Health providers and county officials say they are working to give a clear road map to every person changing providers so they don’t get lost in transition.

Cascadia clients will get letters detailing changes in their care, Walker said. Staff are working to schedule prompt appointments for people switching counselors and to transfer records, including medication notes. Walker and county officials are urging new providers to hire Cascadia employees for the same jobs, though no one can force that.

The timeline adds urgency: With Cascadia losing money every week, the county and the nonprofit want to make the changes as soon as possible.

“It’s a big chore that they have on their hands,” said OHSU’s Keepers, who is not involved in the process. “Especially since Cascadia is such a big mental health provider. There are a lot of people at risk.”

From OPB.com, June 18, 2008

LISTEN to this article.

Mental health clients in the Portland are trying to figure out where they’ll be getting their care today.

Monday local government officials unveiled the blueprint for the area’s mental health care future.

The plan, on its face, shrinks the troubled nonprofit provider, Cascadia Behavioral Healthcare, by about a third. But since Cascadia is the largest mental health care provider in the state, the restructuring will have huge ripple effects.

+++

Since late April, taxpayers have given Cascadia more than $3 million in loans and cash advances.

Everyone involved acknowledges that without the bailout, the regional mental health system would have failed.

No one knows exactly what that would have looked like.

But many clinically depressed and schizophrenic patients would have missed their treatments. Even more recovering drug addicts and alcoholics would have been without help.

Suzanne Nord: “The ultimate thing is to provide housing and keep people off the streets.”

Recently, Suzanne Nord rolled into the Benson High gym in her wheelchair. She was one of more than a-hundred people who came to meet with Cascadia and county officials about how the current crisis will affect her life. She lives in an apartment complex Cascadia runs for the mentally ill.

Suzanne Nord: “I don’t want to be on the streets. That will make me crazier than I am already. To keep people out from under cars, and out from behind dumpsters, you need a place to sleep, that you feel safe. And that’s the beginning of being a human being again.”

Caring for people like Nord is exactly why the state and county needed to bail out Cascadia, officials say.

But if you look at the nonprofit’s books, its financial mismanagement and misplaced priorities left the government with little choice.

Derald Walker took over as the chief executive at Cascadia this year.

He says today’s crisis isn’t unique to Oregon.

Derald Walker: “Increasingly, running nonprofit healthcare is demanding. If you look at the number of places similar to Cascadia across the country, the numbers that are folding is very high.”

For the mentally ill, it’s especially difficult. Their costs are dramatically higher than most for things like medication, therapy, and in-patient housing. And the mentally ill are far more likely to live below the poverty line and be without job-sponsored health care.

Which is where the financial mismanagement comes in.

Because so many of Cascadia’s clients are poor, Walker says, they rely on Medicaid to pay their bills.

Derald Walker: “And Congress, in 2001, passed a bill that increased the accountability for Medicaid funding considerably, that required more data.”

Walker says Cascadia had more than a little bit of trouble meeting those new requirements.

Derald Walker: “It’s not like doing an appendectomy where you have some specific tangible costs, like operating rooms or the cost for a pacemaker. People with chronic mental problems need more services that are difficult to document and they don’t involve direct face-to-face contact that you can always document.”

Already, Cascadia owes another $2 million to the state because it can’t prove it provided some services over the past three years.

Trisha Baxter is the administrator for the state’s Office of Payment Accuracy and Recovery.

Trisha Baxter: “At this point, Cascadia owes that to the state. If they can come up with additional documentation, then we’d be so happy. There is no doubt that those services were delivered, but we don’t have the documentation to back up the payment of those claims.”

Despite those challenges, most of the other health providers in the state, and in fact in the country, successfully switched over to the new system.

In fact, the county says it actually gave Cascadia a chunk of money to help with the transition.

But Cascadia didn’t just use the funding to try to transition to a new billing system.

The nonprofit used much of the money to help it take over a number of the region’s smaller nonprofits.

Cascadia was formed in 2001 from three local mental health providers – and it continued to grow over the next several years by merging with other operators.

Phil Broyles: “I think they got too large too fast.

Phil Broyles is a former clinician for Cascadia.

Phil Broyles: “They didn’t have the proper systems in place to handle the number of clients they have taken on and all that. I think it was poor planning, I don’t think they planned for this big of an organization.”

Many people inside and outside Cascadia agree.

They say the organization continued to rely on costly, and mistake-prone, paper billing for years.

Cascadia CEO Derald Walker says the idea behind the growth wasn’t entirely flawed.

Derald Walker: “In the world of nonprofit healthcare, size actually can be in your favor because you are not duplicating administrative costs. But with 20/20 hindsight probably they did grow too fast and at some point, they should have consolidated their gains and made sure their financial reporting and such was equal to the size of the organization.”

Walker says since he wasn’t around when those decisions were made he’s not in a position to defend them.

And now, Cascadia is left picking up the pieces.

The transition plan will reduce the number of contracts from Cascadia’s portfolio – meaning it will also reduce the county’s reliance on one dominant operator.

Cascadia employees are being asked to learn new accounting rules – and some say they are being pressured to work harder and bill more. When Cascadia was days away from collapse, many workers stopped showing up for work.

Here’s former clinician Phil Broyles again. He still works for Cascadia’s housing office as a landlord, but says he resigned as a clinician after seeing other employees get pressured to increase their billing.

Phil Broyles: “Nonprofits are supposed to be nonprofits. Their bottom line is to provide a service to the community. And when you operate it like a company that sells widgets, then people get hurt.”

And it’s those people who will be most affected by Cascadia’s troubles. Under the county’s new plan for Cascadia, half the children it serves must transfer to a new provider.

And some patients in Gresham and Portland will need to work with another health care operation.

Right now, the county is accepting input from the public about the plan.

Within a few weeks, officials hope to shrink the nonprofit, reduce the county’s reliance on one mental health provider, and most importantly, stabilize care for the mentally ill.