Mecklenburg blasts Cardinal Innovations for inadequate service. Cardinal disagrees.

After a series of controversies over poor service at Cardinal Innovations Healthcare, Mecklenburg County may sever its relationship with the Charlotte-based organization that coordinates behavioral-health treatment in 20 counties throughout the state.

Cardinal, known as a managed care organization, has routinely failed to provide adequate help for some of Mecklenburg’s neediest residents, said Assistant County Manager Anthony Trotman at the county commissioners meeting Tuesday.

Now might be the time to find another managed care organization for Mecklenburg County, Trotman said, one with stronger capabilities to handle individuals with developmental disabilities, in addition to mental health and substance abuse concerns. More than 195,000 Mecklenburg residents are eligible for Cardinal’s services.

Cardinal executives were not invited to Tuesday’s meeting, Trotman said as he responded to a question from Commissioner Pat Cotham. Still, the commissioners are expected to have conversations with them soon, said Chairman George Dunlap.

Trey Sutten, Cardinal’s chief executive officer, told the Charlotte Observer Tuesday afternoon he was surprised the county would discuss the concerns without advance warning. Sutten, who emphasized Cardinal’s close, collaborative relationship with the county, said that’s not how a partnership is supposed to work.

“What we really want is a constructive engagement with our community partners,” Sutten said in an interview before the commissioners’ meeting. “We’re disappointed they elected to do it this way.”

Disengaging from Cardinal requires approval from the state’s Department of Health and Human Services, Trotman told the commissioners. The public would need a chance to provide feedback, as well.

As Mecklenburg now explores the prospects of a major healthcare transition, it is tasking Cardinal to “develop a formal improvement plan to better address the needs of our community,” Trotman said.

Cardinal, which serves patients who qualify for Medicaid benefits or have no insurance coverage, is also expected to create a shared system that would better monitor its performance with Mecklenburg and other community providers. Currently, only limited data is available for county departments, Trotman said in his presentation.

Concerns at Cardinal

In a string of complaints, Trotman said Mecklenburg’s mobile mental-health crisis response team missed 52 calls for service since December 2019 after funding cuts reduced the number of clinicians from eight to three.

Dietrick Williams, Cardinal’s chief operations officer, disagreed with that assessment. He told the Observer that Cardinal has maintained the status quo and has not cut funding for mobile clinicians.

“We’ve not received any information about missed calls,” Williams said before the meeting. “I honestly do not know what to make of that.”

In a separate complaint, Trotman noted that almost 130 children who were abandoned or neglected last year received “emergency placements.” Yet a number of those youth were denied access to care or received delayed care, he said.

“The county paid for ongoing care and emergency placements — some of which could have been funded by Cardinal if their provider network was adequate and willing to accept our youth,” Trotman said.

Sutten countered that Cardinal and Mecklenburg County have “philosophical differences” when it comes to caring for children. Cardinal is opposed to placing young patients in psychiatric residential treatment facilities, Sutten said.

“I think that’s sometimes where the rub is,” Sutten told the Observer.

‘Push for better’

Following Trotman’s presentation, some Mecklenburg County commissioners described the situation as a “crisis” and said urgent action is needed to restore patient care and standards.

“I’m frankly alarmed at the extent of the problem — this is really bad,” Commissioner Trevor Fuller said. “We are in a mess, and I fear that people’s lives are being put at risk because of this. I think we’re in a world of hurt that’s going to get worse.”

Elaine Powell, vice chair of the county commissioners, said the county is failing its residents.

“I feel so many arguments coming from Cardinal. It’s more about the dollars than the patient care,” she said. “We have to push for better. Human beings are in crisis.”

Yet Cotham cautioned against leveling sweeping accusations without giving Cardinal an opportunity to respond.

Some of the complaints about Cardinal’s service, Cotham said, might stem from funding gaps at the state and federal levels. The organization had a budget of $853 million in 2018.

“We have some severe problems, but I’m not going to lay them all at the feet of Cardinal,” Cotham said. “I want to hear from Cardinal and ask questions.”

Cardinal’s past missteps

Cardinal Innovations replaced MeckLINK, the county’s own behavioral healthcare system that received federal Medicaid funds, in 2014.

Cardinal drew sharp scrutiny in May 2017, when a state audit revealed “unreasonable spending,” including lavish Christmas parties, expensive in-state flights and an inflated salary for Richard Topping, the ousted chief executive officer who was paid more than three times the limit set by state policy.

By November 2017, after Topping and three other executives were paid $3.8 million in severance, DHHS took control over Cardinal and fired its board members.

Commissioner Vilma Leake said Tuesday that Cardinal’s public trust and transparency issues have continued.

“Cardinal has too many problems for me that will not respond to the needs of the people that need it the most,” Leake said. “And their board of directors, to me they are corrupt.”

This story was originally published February 18, 2020 at 10:55 PM.