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The Humboldt County Board of Supervisors engaged with some of the county’s most intractable problems on Tuesday, looking for new approaches in addressing homelessness, mental health care and the slow-motion disaster wrought by its own financial management.

In a morning hearing, the board heard from local health care providers who outlined the immense challenges in local mental health care, which have been exacerbated by the COVID pandemic and insufficient resources.

Roberta Luskin-Hawk, chief executive at Providence Humboldt County, told the board that the entire country is facing these challenges, and at Providence-St. Joseph Hospital things have reached “the breaking point,” with an influx of mental health patients causing a surge in workplace violence and impacting core services in the emergency department.

“I think we’re at the point where we need help from the Board of Supervisors, really looking in a very global way,” Luskin-Hawk said. “Many of the [local] health care leaders have said we need a gap analysis to look at everything from outpatient care to crisis stabilization to inpatient care to post-acute chronic care, and we really need to know what we have and what we need.”

In recent years and months the hospital has been forced to manage an increasing number of patients on so-called 5150 holds — that is, patients who’ve been deemed potentially dangerous to themselves or others and confined involuntary for up to 72 hours. Many children have been held at the hospital even longer, Luskin-Hawke said, and recently the sheer number of them meant some were placed in hallways so medical staff could attend to other emergency room patients.

That environment became a “pressure cooker,” she said. “It’s noisy. It’s scary. It escalates them. It’s not good care for them … [and] our staff is overwhelmed because they’re not trained primarily in mental health.”

Experienced nurses didn’t feel safe in the workplace, and they began leaving in significant numbers. Hospital administrators have worked with the county Department of Health and Human Services (DHHS) on temporary fixes, including visits from the county’s mobile response team. 

“But, really, we should be looking at [is], What would the best care look like and what resources would it take to make that happen?” Luskin-Hawk said.

Paul Bugnacki, the county’s deputy director of mental health, gave a bit of historical context to state and local mental health care and noted that Humboldt is one of just two counties in the state that operates an acute psychiatric hospital — the 16-bed Sempervirens facility in Eureka.

That’s not nearly enough to manage the county caseload, Bugnacki said. A recent report from the California Hospital Association found Humboldt County should have 68 beds for inpatient acute psychiatric care, given its population. And yet the county’s state’s psychiatric bed capacity shrank considerably between 1995 and 2016, declining by 42 percent.

[CORRECTION: That last sentence originally said there had been a reduction in the number of psychiatric beds in the county. However, Humboldt’s number has been steady at 16 since 1968. The Outpost regrets the error.]

The current problems with mental health care date back to the 1960s when the closure of state-run mental hospitals occurred, “releasing individuals back into their home counties without a comprehensive plan to support and sustain systems of care for those suffering from mental illnesses,” Bugnacki said.

Humboldt County has been designated a “critical shortage area” for licensed health care providers by the Health Resources and Services Administration, which allows providers to offer certain hiring incentives including a loan repayment program.

“But this is not enough to attract and compensate quality professionals to come work for us,” Bugnacki said. The county has engaged staffing agencies to fill the gap, but those employees are temporary and charge higher rates than what full-timers make.

Meanwhile, the county has been working to get an adult crisis residential facility up and running, but staff have encountered issues including NIMBYism, he said. Meanwhile, COVID led the county jail — which is a designated mental health treatment facility — to book only felony offenders, prompting an influx of minors being admitted to the county’s Crisis Stabilization Unit. 

“It’s not a sustainable solution,” Bugnacki said. 

First District Supervisor Rex Bohn asked the county’s behavioral health director, Emi Botzler-Rodgers, how she’d solve these problems if she had “pixie dust” to throw at them. 

Lacking pixie dust, Botzler-Rodgers focused on smaller goals, saying the county recently obtained about $200,000 through a Mental Health Block Grant to hire case managers to help people in mental health crises. Her department was seeking board direction on how to allocate those funds.

Third District Supervisor Mike Wilson said this relatively small amount represents “a Band-Aid approach,” and Luskin-Hawk agreed, saying the county needs to look for “broad and robust” solutions.

Fifth District Supervisor Steve Madrone suggested approaching the problem via the county’s facilities master plan, possibly by converting a county-owned parking on Eureka’s Fifth Street into a multi-story DHHS building complete with a new Sempervirens location.

“You know, with the huge state surplus that’s happening right now, I think it’s an excellent time to sit down with [state] Senator [Mike] McGuire and Assemblyman [Jim] Wood’s staff with our staff at DHHS and our hospital leaders and really have a really solid conversation around where we’re heading with this.”

Until then, Band-Aids will have to do. The board authorized staff to negotiate with Providence over how the $200,000 grant will be spent and come back in three months with a status report.

Housing Trust Fund

In the afternoon, the board unanimously agreed to submit an application to the California Department of Housing and Community Development for up to $1.5 million. That money could be matched with another $1.5 million in American Rescue Plan Act (ARPA) funds to establish the Humboldt County Housing Trust Fund.

The idea behind this fund is to stimulate development of more affordable housing countywide, including construction and financing loans to build multifamily rentals, emergency shelters, transitional housing and permanent supportive housing. Funds could also be used to help low-income families purchase or rehabilitate homes or help cover costs of construction, conversion, repair and rehabilitation of accessory dwelling units.

Planning and Building Director John Ford said DHHS has another $200,000 in grant funding to contribute to the effort, bringing the total to $3.2 million. Wilson noted that this is “a pretty significant chunk of money” and said it may be time for the county to reevaluate its approach, structurally, to addressing homelessness and housing. 

Andrew Whitney, housing and grants coordinator with Planning and Building Department, said county staff has begun focusing on developing housing for those making 60 percent or less of the region’s median income, which works out to $29,850 annually for individuals and $41,800 for a family of four. 

Bohn voiced frustration and impatience over the apparent lack of new housing development, and he asked Whitney to be specific.

“What would you do with that [money] tomorrow if you had it sitting right in front of you? Would you go buy a piece of property and start building stuff?” Bohn asked. “… I mean, because everybody asks, when are we going to build something? Because there’s a lot of money floating around but we don’t seem to be building a lot.”

Whitney acknowledged that it has been a while since the county built a housing project, and he offered a fishing analogy. “Basically what this does is it baits the hook,” he said. “It baits the hook. And we don’t have a project specified. I wish we did. But we are working with partners in the community … that would bring forward a proposal to utilize this funding.”

Wilson said it’s important for the county to establish a Housing Trust Fund. 

“It’s like creating the bank account to show that we’re serious, and I know there are funds and programs that require that you have a Housing Trust Fund in order to be able to get those that funding,” he said.

Madrone noted the wide variety of local organizations and program — both within the county and outside of it — working on this issue. He said it may be time for the county to take a step back and evaluate the big picture, much like the board discussed earlier in the context of mental health care. 

“Soon we really ought to sit down and think about these different programs and how we can clarify the roles of each of these organizations and maybe even make them more efficient and able to move forward on their particular missions,” Madrone said.

Bohn offered one of his characteristic analogies, saying that when it comes to local efforts on housing and homelessness, “We’ve got a lot of people swimming in the same direction but we’re in a bag.” Then, with a callback to Whitney’s own analogy, Bohn added that the county should “get them all out of the bag and they can go fishing.”

DHHS Director Connie Beck, appearing via Zoom, said that while this money may not fund any individual housing project, it could fill funding gaps for a variety of local developers, helping multiple projects come to fruition. 

“I think there’s a lot of potential out there,” Beck said. And she challenged Bohn’s characterization of the broader situation, noting that right now, 199 units financed through the state’s Homekey program are going in across the county. 

“There’s a lot of work that’s been happening,” Beck said. “I apologize if you’re not up to speed on all of those, but there’s a lot of really good work happening and staff have been working really hard on this.”

The board approved the grant application and directed staff to develop a public process for deciding how the funds will be spent. The vote was unanimous.

Delinquent Financial Reports

It’s not news at this point that numerous financial transactions and reports, spanning multiple fiscal years, have not been completed, leading to a cascade of management challenges and a steadily growing tally of lost revenues. (A spreadsheet attached to Tuesday’s agenda lists the delinquent reports, the associated risks and the total number of days they’re late.)

“These transactions and the lack of data that is available is posing a challenge for my office in proposing a responsible and well-informed budget to your board,” County Administrative Officer Elishia Hayes said.

Chief Financial Officer Tabatha Miller was on hand with newly appointed Treasurer-Tax Collector Amy Christensen to discuss those challenges and propose a modified schedule for adopting a budget for the upcoming 2022-23 fiscal year. 

Miller said the most important of the outstanding reports is probably the 2019-20 Single Audit, which had a COVID-extended due date of Sept. 30, 2021. The county has $93.7 million in state and federal pass-through funding that’s dependent on completion of that report, Miller said. 

Meanwhile, of course, the State of California is suing Auditor-Controller Karen Paz Dominguez for failure to meet government-mandated financial reporting requirements, and the county recently filed a cross-complaint against her. 

The county is facing repercussions from various granting agencies, and Miller said they’ve begun to take action. For example, the state’s Employment Development Department (EDD) has issued a cash hold on important workforce program funding, and a continued delay could result in partial suspension or termination of those funds.

Plus, the delinquent single audit must be submitted before the District Attorney’s Office can collect $413,000 from the state for victim witness protection. Caltrans has placed a hold on funding for new projects, and the U.S. Department of Agriculture has also cut off funds to the county. 

“The stakes are becoming more and more dire,” Miller said.

Still, county staff plan to submit an initial 2022-23 budget for the board’s consideration in June, though they recommended that the board postpone final adoption of that budget until late September, when staff expects to have a better understanding of the county’s financial picture. 

Miller said the county has been busy trying to catch up on bank reconciliations, a regular bookkeeping task that, until recently, hadn’t been completed in nearly three years. 

Miller also addressed the county’s “missing $28 million,” a discrepancy between check totals cleared by the bank and county financial records submitted to outside accounting firm MGO by the Auditor-Controller’s Office. Miller said that by taking a closer look at check records for one particular day she was able to find the missing checks, identify the associated vendors and conclude that the money’s not really missing; it just wasn’t recorded properly. 

“So we’re not real sure what happened or why [MGO] didn’t get the proper information,” Miller said. “But it’s a little frustrating because it did end up creating quite a bit of work on their part, which essentially cost the county money, but it also means that we didn’t get bank reconciliations turned back over from them.

Instead, the county got a list of 3,650 checks that need to be individually verified, traced back to valid vendors and invoices.

Paz Dominguez called in via Zoom and offered to clarify how the county got to this point. She said that if the CAO’s Office had made any attempt to engage with her office “beyond one meeting,” or to collaborate on the day’s presentation, then she wouldn’t need to clarify the situation publicly.

Regarding the missing $28 million, Paz Dominguez said the county’s financial reporting software used to send the relevant reports to MGO automatically, and she suspects that a “forced hotfix” on that software is probably responsible for subsequent issues.

She went on to say her office has not been receiving timely information from the Treasurer-Tax Collector’s office, which makes it “very difficult for our office to even attempt to reconcile the bank statement anywhere near 10 days after the end of the month.”

The delays have also prevented her office from issuing an outstanding check register report.

“So maybe [Christensen] could speak to that and I would love for her office to reach out to my office, or vice versa, so that we can settle on a schedule for when we can expect deposit information and when we can expect checks to be cleared in the system.”

Paz Dominguez said many of the financial reporting issues under discussion are not actually new, and at this point her office is “not being invited to the discussion or to the table.”

Neither Hayes nor Christensen jumped in to respond to Paz Dominguez’s comments, but Second District Supervisor Michelle Bushnell asked them to provide some clarification. 

Sounding weary, Hayes said, “You know, honestly, I don’t know that it’s helpful to the conversation. Ultimately, we’ve been coming to your board and discussing this since 2020.” 

Referring to the broader fiscal management issues, she continued, “This has been a problem for two years, almost all of these transactions that we’re speaking of today, and it’s come to a critical juncture where it’s impacting my office’s ability to make prudent and responsible financial decisions for your board and to bring good recommendations before your board on how the next year’s budget should be prioritized and allocated.”

The board wound up voting unanimously to accept staff’s recommendation, aiming for a tentative “place-holder” budget to be established in June with a final one adopted before the state’s October 2 deadline.