To Whom It May Concern:

The purpose of this letter is to file a formal complaint against Multnomah County Verity Integrated Behavioral Health Care Systems. I am an OHP Plus recipient; my case is managed through DHS’ department of Aging & Disability.  The complaint is regarding VIBHCS’ policies and procedures.  I have been seeking treatment with Portland DBT for over two years now.  Their program hosts a purely applied DBT program.  I am diagnosed with Borderline Personality Disorder, Major Depressive Disorder, Anxiety Disorder, and Agoraphobia/Panic Disorder.  I was originally referred to Portland DBT through N.A.R.A. in 2006 and have received two additional referrals since.  (name omitted) with Western Psychology, recently contacted VIBHCS to express her support of Portland DBT as a treatment plan and to advocate for my client choice rights.  Unfortunately, both (name omitted) requests and mine have been met with indifference and without consent or clear explanation.

ISSUE 1 – FAILURE TO PROVIDE CLIENT WITH VIBHCS POLICY, PROCEDURES, AND MEMBER RIGHTS/RESPONSIBILITIES

At the time that I initiated communication with Verity, I was not offered any information regarding Verity policy, procedure or member rights, and responsibilities.  When I requested this information be faxed to me, I was told that VIBHCS would not provide the benefits of faxed information and was, alternatively, assured that the requested information would be mailed to me promptly.  I still have not received the requested information.  In order to compensate for the informational disadvantage, I sought assistive information through the DHS web site and The Oregon State Legislature’s on-line archives.

A verbal disclosure of Verity authorization protocol pertaining to Portland DBT is the only information I received directly from VIBHCS.  It was disappointing but unsurprising to find that VIBHCS authorization criteria lacked implementation of senate bill 267’s evidence based practices guidelines, and when I questioned the framework that motivated VIBHCS’ authorization criteria, I was offered no logical or valid explanation.  Upon reviewing assembled VIBHCS, OHP, and OAR data, it is my conclusion that VIBHCS is, first, a capitalist enterprise, whose primary objective is generating revenue, and cutting costs.  While phone staff was patient and considerate, they were not helpful.

ISSUE 2 – FAILURE TO PROVIDE ACCESS TO SERVICES DESPITE MULTIPLE, DOCUMENTED REFERRALS AND BPD EVIDENCE BASED PRACTICE OF DBT

Verity's policy contradicts the implementation of BPD Evidence Based Practices.  Dr. Marsha Linehan, DBT's originator states,

"The intense suffering that accompanies borderline personality disorder, both for the patient and for the community surrounding the patient, suggest that a high priority must be put on both developing new more effective treatments and on dissemination of those that are currently available.  This is especially true in community mental health where in some states the lack of improved outcomes with some treatments have led those controlling reimbursement to refuse to treat or pay for treatment for BPD patients. Although a case might be made for some that an ineffective treatment is more harmful than no treatment, the same cannot be said for treatments that have been shown to be effective in rigorous clinical trials.”  (The Journal of the California Alliance for the mentally ill, Linehan).

Verity's DBT authorization policy summarized + contradictions explained:

·                   Utilization of acute crisis Services

o                 This criteria undermines the importance of prevention and encourages maladaptive/suicidal behaviors

·         Trial out-patient ineffective

o        Disregards OAR guidelines requiring prioritization of evidence based practices

·                   Currently in treatment

o                 Purely applied DBT does not approve nor recommend dually enrolled, unrelated treatment services

·                   no drug dependency issues

o                 A Blatant disregard of DBT’s target treatment group; chronically suicidal, BPD females with substance abuse issues.

In addition, I would like an explanation as to why VIBHCS’ DBT authorization policy fails to address BPD concerns.  It is inexcusable that a MHO can construct authorization policies to suit their own agendas with little or no regard to scientific evidence, state laws, or their own proclaimed values and principles.

ISSUE 3 – GENERAL ATTITUDE TOWARDS AUTHORIZATION REQUESTS AND CLIENT CHOICE RIGHTS

I explained to Verity staff that my reason for choosing Portland DBT was their strict adherence to the original DBT program model.  They are the only provider in the area who offers the rigorous and intensive program.  VIBHCS responded by suggesting that Portland DBT offers no considerable advantages over Verity providers.  Specifically, I was told that, "It's not the end of the world if you can't get into Portland DBT. I know that you would like to be in their very expensive program. Our providers may not be as fancy as Portland DBT, but you may have to accept that you may not be eligible to receive their services through our guidelines."  

I cannot accurately express how angry, sad, confused, helpless, and hopeless I felt after having come so far.  The experience has prompted the worst aspects of my illness to surface and I am now considering giving up on this completely hopeless two-year crusade.  Since associating with Verity My mental state has only worsened.  Where I had only 1 to 2 episodes of crisis per week, it is now daily.  The last argument I had with Verity initiated a depressive episode that caused me to not leave my bed for 7 days except to use the bathroom, I was so fed up with fighting that I was even considering checking myself into the hospital so I could kill myself without having to expose my loved one to the messy details.  I know that if I do not get support soon, I will either die or end up in a mental institution.  I want to get the help I need so I can have a chance to get better, but I cannot take this fighting or limbo for much longer.  I am stretched beyond my limited abilities to cope.  Dr. Linehan aptly describes my current situation and the BPD dilemma, "The individual and the environment co-create each other over time with the individual becoming progressively more emotionally unregulated and the environment becoming progressively more invalidating." 

Thank you for taking the time to consider my complaint.  VIBHCS policies and procedures need a thorough examination not only for verification of OAR adherence, but also for the sake and safety of all Multnomah County residents who suffer from mental illness and rely on Verity to provide them access to quality, appropriate care. 

People should not have to fight, argue, beg, or file complaints in order to gain access to care.