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State Objects to Dr. Hogan’s Second Monitoring Report

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On September 22, 2022, the State’s attorneys filed objections to Dr. Michael Hogan’s second monitoring report in the ongoing mental health lawsuit, stating “the Remedial Order (ECF 278) does not contain recognized, objective criteria for determining what constitutes compliance with each of its ‘obligations’.” The State’s complaint begins with general concerns about the lack of objective criteria for monitoring and the monitoring process leading to “mission creep.” The lawyers then list seventeen specific objections to Dr. Hogan’s report, including that he did not factor all of the State’s feedback into the report he submitted to Judge Reeves.

The State objects to Dr. Hogan’s discussion of care coordination, stating that care coordination was never discussed at trial. Although we don’t have the trial transcripts, we know at least one expert, Dr. Melodie Peet, discussed care coordination in her report, “Case management and care planning are continuous, and a unified treatment team designs the care for an individual. When there is a single point of responsibility, providers cannot ‘pass the buck’ as the person receiving care moves through the system.”

The State describes Dr. Hogan’s framework for assessing compliance as “problematic for several reasons.” From their filing:

 First, it does not exist in the Remedial Order. Second, parts 2 and 3 of the framework are not tied to any objective criteria (for example, parts 2 and 3 do not identify how it is to be determined whether an action is working as intended or whether the action is contributing to the goal of reducing unnecessary institutionalization in Hospitals). Third, because parts 2 and 3 of the framework are not tied to any recognized, objective criteria, compliance with the vast majority of the paragraphs of the Remedial Order depends on the ‘professional judgment’ of a monitor.

One way to at least partially address the State’s concerns about objective evaluation would be to implement the clinical review process demanded by the remedy (page 6, item 23). Here’s what the clinical review process would look like:

To assure that services are working as intended to address the needs of people with serious mental illness and to achieve compliance with the ADA, the State will design, with the participation of the DOJ and the Monitor, a Clinical Review Process to assess the adequacy of services received by a small sample (e.g., 100-200) of individuals receiving Core Services and/or State Hospital care. Consultation with the DOJ and Monitor will address at least: sampling, evaluation criteria and instrument, scoring, reviewer training and reporting. The agreed process will be used by the state on an annual basis, beginning in FY 22 and until the case is terminated, to assess the adequacy of services and procedures in the system and to provide data to the State to make improvements and to the Court to determine compliance.

Unfortunately, the State fought to get this term stayed, and it was. We encourage the State to pursue a reversal of the stay and then work with the DOJ and Dr. Hogan to create an agreed-upon objective clinical review process.

The article “Mental health agency, AG at odds over court-appointed monitor’s work,” by Isabelle Taft in Mississippi Today on September 28, 2022, offers additional insight into the State’s filing. The respective influence that the DMH and the AG’s office have over this lawsuit is confusing. The DMH has repeatedly told Families as Allies that the AG’s office decides the State’s course and response. At the same time, the AG’s office tells us it relies on the DMH for subject matter expertise to determine its course of action.

We strongly encourage the DMH to use its influence to stop the AG’s office’s continued legal maneuvering so that the state can focus all funds and efforts on creating a responsive system of care for mental health. Recent news indicates state agency heads may influence how attorneys represent them more than previously suggested.

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