Shortly after Gov. Mike Beebe took office in 2007, he vowed to change the way Arkansas provided mental health care to its children.
He was acting on a study commissioned by the state legislature that had found that the state's policies were out-of-date with current medical opinion, that regulation was fragmented and ineffective and that the state was spending an inordinate amount of Medicaid dollars (according to our figures the second highest in the nation) on residential mental health care.
What Beebe's reform has sought to do is upend a system created during his predecessor's administration that in part allowed health care providers to regulate themselves. It was a system, which, under Gov. Mike Huckabee, became controlled by providers of health services who tended to share Huckabee's evangelical religious philosophy.
One of the central figures in the Huckabee era was Ted Suhl, the owner of the controversial Lord's Ranch home for kids near Pocahontas and a powerful political player who's been written about in these pages before.
Is there anything to show for the governor's professed interest in reform as he nears 2010 and a run for a second four-year term?
The short answer:
One obvious change is that Suhl, thanks to a new Beebe appointment, is no longer a member of the state board that regulates facilities such as his. Structurally, though, the changes have been slower in coming and there's been little shift in Arkansas as a place that spends a disproportionate amount of money on residential care for troubled kids.
DHS has created a Quality Assessment team to coordinate facility reviews by the various Medicaid contractors and DHS units that audit billing practices and do clinical reviews. That big picture look has produced what DHS spokesman Julie Munsell called “active reviews” of three providers of out-patient mental health care, including, as it happens, a Suhl-controlled business.
Under the company name Maxus, Suhl operates Arkansas Counseling Associates in towns across Arkansas. The “deficiencies,” as DHS terms them, reported at Maxus don't rise to the level of abuse, Munsell said. But they do allege rubber-stamped diagnoses for 59 patients and 58 out of 59 treatment plans at its Dumas clinic — something that DHS reform particularly addresses in its efforts to personalize mental health care.
DHS is seeking Medicaid refunds of a total of $134,714 for deficiencies found at Dumas and Benton. It's seeking much more — $294,738.64 — from a non-Suhl agency, Therapeutic Family Services, for deficiencies at its North Little Rock, Hot Springs and Lewisville clinics, and $208,917 from another non-Suhl agency, Living Hope Southeast Inc. of Monticello.
But DHS' Division of Behavioral Health has completed a clinical review at Suhl's Dumas clinic that goes into more detail than the billing deficiencies found by Medicaid's Program Integrity Unit. (Therapeutic Family Services and Living Hope are currently undergoing clinical reviews.)
Suhl has declined multiple requests to talk to the Arkansas Times on this or any other topic.
Beebe's focus on the state's mental health care system — with Act 1593 of 2007 that created the Arkansas Children's Behavioral Health Care Commission and which has brought about operational change at DHS and its Division of Child and Family Services — did more than change process; it has brought at least some change in politics.
Beebe has changed the face of the Huckabee-created Child Welfare Review Board, replacing Huckabee insider Suhl in 2008 and James Balcom, who urged the creation of the board and supported its move to prohibit homosexuals from being foster parents, earlier this year. Suhl he replaced with Beverly Foti, who is with Medicaid contractor APS Healthcare, and Balcom with Andy Altom, Methodist Family Health president.
Beebe reappointed two Huckabee appointees, however — Charles Flynn of Arkansas Baptist Homes and David Whatley, founder and chief administrator of Watersprings Ranch, a Christian children's home in Texarkana. And Beebe has made no move to change the law that put providers of residential treatment in oversight positions for their own industry.
Beebe also named Jay Bradford and Tommy Roebuck — two former state representatives who had opposed Suhl's activities in the state legislature — to serve on the Children's Behavioral Health Commission.
But, despite Beebe's strong beginnings, state work on changes in mental health have mostly been quiet and behind the scenes, with little change in the state's expenditures. Quiet IS different, however, compared with some of the tumult of past years.
This week, the Times provides a look back at those years in cooperation with a former Wall Street Journal reporter, as well as this update on progress.
In 2008, reporter Mary Jacoby began work on an article about Suhl and his relationship with Huckabee for the Wall Street Journal. Huckabee had just won the Iowa Republican caucus for the president nomination, and the Journal asked Jacoby to go to her home state of Arkansas to take a deeper look at his record. Among the things she found was the Arkansas Times' report in 2006 that a plane owned by one of Suhl's companies had ferried Huckabee, his family and staff to a political event in North Carolina as he explored his presidential run.
In a follow-up cover story, the Times reported that Suhl had received $8.5 million in public funds during the 2006 fiscal year, and noted that he'd provided Huckabee the plane just as the legislature was gearing up to investigate waste and inefficiency in child mental health treatment. The Huckabee campaign paid for the flight, but the story and related coverage led to an exploration of the history of the Lord's Ranch's conflicts with DHS and Suhl's substantial political contributions to lawmakers
Jacoby thought the relationship with Suhl might shed light on how Huckabee melded his conservative Christian beliefs with real-world governing. The Times helped her by providing copies of FOIA request responses it had received from DHS about inspections of the Lord's Ranch back to the early 1990s.
When Huckabee no longer figured as a presidential candidate, the Wall Street Journal lost interest in the story. Jacoby completed work on an article on the subject earlier this year as a freelancer for the Times. Some of Jacoby's story, provides background into the state's mental health care for children.
Warm Springs is a tiny hamlet in rural northeastern Arkansas just south of the Missouri border. A shuttered white clapboard convenience store stands at a lonely crossroads, across from a hill dotted with three wooden crosses and rocks with the letters J-E-S-U-S painted on them.
But up a long unmarked gravel road in this isolated corner of Randolph County is a big business: The Lord's Ranch. A children's psychiatric home owned by Ted Suhl, The Lord's Ranch and other Suhl-family mental health facilities took in $95 million in state Medicaid funds between 2002 and 2008, according to figures from the state Department of Human Services.
The closest town of any size — Pocahontas, population 6,500 — is nearly 20 miles away. Hand-painted signs are nailed to the trees along the gravel road. “Love Lifted Me,” reads one. “Thank You God,” proclaims another. White crosses are planted in the ranch's fields, alongside grazing horses. A sign welcomes visitors with a quote from the Gospel of Mark: “And they brought unto Him little children.”
The story of how Ted Suhl's self-described “Bible-based” mental health home for troubled kids has flourished is a tale of Arkansas's expensive state mental health system. It is a system that has tried, but too often failed, to help low-income families with emotionally disturbed or mentally ill children.
Suhl was a major player in shaping the system. He employed lobbyists in the state Capitol. Medicaid funds kept flowing to mental health providers. Suhl also made friends in state government with generous political donations.
A political ally of then-Gov. Mike Huckabee, Suhl took some of his governmental concerns straight to Huckabee's office suite in the state Capitol, sources said. Huckabee, for his part, appointed Suhl to a state board that licenses child care facilities — including The Lord's Ranch.
But there was a problem: Kids in Arkansas weren't getting quality mental health care, according to an outside consultant hired by the state in 2006 to evaluate the Medicaid program.
Parents were too often excluded from treatment and kept in the dark about their kids' diagnoses. Outside experts concluded that a disproportionate number of kids were being sent by juvenile courts to institutional care. And regulatory improvements were being blocked by the state legislature, consultant Cliff Davis, a former Ohio state mental health official, found.
The Lord's Ranch has served as a high-profile representative of the system. Over 15 years, tens of millions of public money flowed to the facility. With it came problems. State records document complaints of child abuse, accounting irregularities, involuntary religious instruction and other issues.
In the 1990s, kids told Arkansas child welfare inspectors about rough “take downs,” in which staff wrestled them to the floor, planted knees in their backs, and pulled their arms behind them until they screamed, according to inspection reports released under the state Freedom of Information Act.
Some children told state inspectors in the 1990s that The Lord's Ranch had taken them to Mexico to hand out Bibles. One girl told an inspector that when she complained of an ear infection, a Lord's Ranch staffer initially denied her medical treatment, saying, “It's nothing but a demon,” a report released under FOIA said.
Suhl, who would not take questions from Jacoby, hired a powerful Washington lawyer, Bob Bennett, who was President Bill Clinton's personal lawyer in the Paula Jones case. Elite Washington lawyers such as Bennett typically charge $1,000 an hour, according to Washingtonian magazine.
“Allegations that the Lord's Ranch abuses or in any way mistreats the patients trusted to our care are flatly untrue,” Bennett said in a written response. He repeatedly raised the possibility of a lawsuit for reporting about allegations made against the Lord's Ranch.
About a year before Huckabee's ride in the Suhl-owned plane, then-Reps. Jay Bradford of Pine Bluff, Buddy Blair of Fort Smith and Tommy Roebuck of Arkadelphia had begun taking notice of ArkansasÅfs ballooning spending on mental health services for the poor.
The tab for all agencies, not just Suhl's, calculated in 2007: $240 million a year, nearly double 2003 levels. The legislators pushed through a law requiring a study of how effectively the money was being spent.
The state hired former mental health official Davis as a consultant. In 2006, Davis produced a report that described fragmented, ineffective regulation of children's mental health services.
A disproportionate number of Arkansas youth were being shunted into institutional care — which was reimbursed at a higher rate than more effective community and family-based treatments, Davis concluded.
Institutional settings that isolate children from their family are out of favor as a form of treatment, leading mental health experts say.
“We recognize that residential treatment is very costly in terms of money, and also in emotions,” Gary Blau, the chief of the Child, Adolescent and Family Branch at the federal Substance Abuse and Mental Health Services Administration, told Jacoby in an interview.
Davis, the state consultant, agreed. “Placement into secure treatment facilities is not an effective treatment approach for most children with serious emotional disturbances,” Davis wrote in a cover letter to his 2006 report to the state.
Davis' report also described how mental health providers lobbied the state legislature and manipulated juvenile courts.
“Some stakeholders report that providers benefiting financially from an unregulated … system have successfully lobbied the legislature to block regulatory strategies,” Davis wrote.
“Decisions to place children in bed-based treatment facilities are made too often by judges who have adopted the practice of ordering children to specific facilities,” he added.
Davis' report didn't name names. But Suhl played a major part in this system, with critical support from the Huckabee administration.
To be sure, Suhl wasn't alone. National for-profit mental health chains such as BHC Pinnacle Pointe Hospital, Rivendell Behavioral Health Services and Charter Behavioral Health Systems moved in, helping drive the spending.
The providers were taking advantage of a change in the state Medicaid reimbursement rules in 2000 that had opened the door to any provider to treat poor children for emotional disturbances. Previously, only about 15 community non-profit organizations had been eligible for the Medicaid reimbursements.
But it was Suhl who relentlessly lobbied to keep the state Medicaid spigot open, Bradford and other former state legislators told Jacoby.
Just how far out of the mainstream had Arkansas become in shipping emotionally troubled kids off to mental health institutions? To find out, Jacoby asked the federal Centers for Medicare and Medicaid for data and matched it to state census reports.
What the data showed was eye-opening: Arkansas sent more than 5,600 kids into institutional mental health care in 2005. The state was second only to Alaska on a per capita basis in treating emotionally disturbed children in institutional settings.
In July 2006, then-Rep. Blair convened a legislative hearing to examine conditions at The Lord's Ranch after receiving what he called “too many complaints” about it.
Blair made public an excerpt of an e-mail from his wife's cousin, whose granddaughter had been treated at the ranch.
“One punishment was to put them on the floor and a staff member to sit on them,” the e-mail released by Blair said. The granddaughter “also mentioned being put in a straight jacket. And also having her arms pulled back behind her back to the point that it was very painful. She also said something about having to stand all day for a punishment,” the grandmother's e-mail said.
Suhl testified at the hearing that “therapeutic holds” were used only when patients tried to attack staff members. He said he knew of no staffers who handled children as described in the e-mail. If they did, they would be disciplined, Suhl said, according to news reports.
Ira Burnim, legal director of the Judge Bazelon Center for Mental Health Law in Washington, D.C., said it's not uncommon for facilities to take a punitive approach to mental health treatment.
“The idea is, ‘Get tough with them, and make clear if they don't shape up, they're going to suffer more pain,' ” Burnim said. “We have ample evidence that that approach doesn't really work.”
The Lord's Ranch was founded in 1976 by Suhl's parents, Bud and Shirley Suhl.
In 1987 the ranch was licensed by the state of Arkansas to provide mental health services. Most of its patients came from Chicago and the Dallas area; at the time, the ranch wasn't eligible for Arkansas Medicaid funds.
In 1990, a state regulatory board voted to revoke its license, based on allegations of use of improper restraints and falsified records. But the board later reversed its decision, putting the Lord's Ranch on temporary probation. Its status eventually reverted to regular.
The ranch had licensed therapists and a physician on staff. It also operated a school for kids, who would stay for treatment up to a year.
The rules were strict: boys and girls could not talk to each other, and parents weren't allowed contact with their children in the first 30 days of their stay. After the first 30 days, a monthly visit was allowed. A frequent punishment was called “standing on the wall.” Children would be forced to stand all day, sometimes for days or even weeks, against a wall, former residents and staff told Jacoby.
Bennett, again responding for Suhl, said “standing on the wall” ended in 2005. He described the practice as a “time-out” for aggressive or unruly kids. He said visits and phone calls are restricted in the first 30 days to “ease the transition.” But he said the Lord's Ranch does “not monitor patient mail or telephone calls.”
Bible study was also an important part of every day, former residents said. Involuntary religious instruction at Medicaid-funded facilities is against federal rules. Bennett described the religious activities as “limited to non-denominational church services three times a week” in locations off ranch property. “Attendance at all church services is voluntary,” he said.
But former residents told a different story, at least as to practices in years past.
The Bible-study sessions “are voluntary only if you don't want to stand on the wall all day,” said Elena LaReau Konar of Indiana, who was a teen-aged patient at the ranch from 1995 to 1998. “There's nothing voluntary down there at all. Well, what else are you going to do if you're not in Bible study? You stand on the wall or you copy passages from the Bible.”
Other youths found they benefited from the strict regime. “I was a bad kid. I was rebellious,” Kaleb Newman of Bossier City, La., told Jacoby. Newman was placed at the ranch at his parents' expense for nearly two years in 1992 and 1993. “The Lord's Ranch did help me.”
Bud Suhl was soft-spoken and “would use the Scriptures out of the Bible to explain to you what you were doing wrong,” Newman said. Bud's son, Ted, who ran the administrative side of the ranch, was stocky and muscle-bound. He struck Newman as more matter of fact. Ted Suhl was “mostly about business,” said Newman, who was 29 years old and working as a sound engineer in clubs in Louisiana when Jacoby interviewed him in 2008.
In 1992, when Newman was a 12-year-old resident of the ranch, an administrator grabbed him and fractured his arm. State inspectors suspected child abuse, the state documents show. Both Newman and his father told Jacoby the injury to his arm had been accidental. The incident appeared to heighten tensions between the Lord's Ranch and its regulators.
In 1993, a 22-year-old named Steve Candalario answered an ad in a California newspaper for a staff position at the ranch. Candalario had worked for the California Youth Authority and liked helping kids. He is also a Pentecostal Christian, and says he was attracted to the ranch's Biblical mission.
Candalario told Jacoby he witnessed several instances of abuse. The most serious, he said, involved an 11-year-old boy who'd acted up in class and strayed into a girls' locker area.
Candalario and another counselor were called to deal with him.
“The counselor became irate,” Candalario said. “He picked this kid up, threw him against the lockers, smacked his head, threw him on the ground. Then he threw that kid into this empty classroom. And the whole time, I'm standing there with my mouth on the floor.” But Candalario kept quiet. “I was kind of intimidated. We were out in the middle of nowhere. It's not like I could go into town. I couldn't even call nobody. They had come up with some cockamamie reason why I wasn't allowed to use the phone.”
After the other counselor had left, Candalario said he tried to console the boy. “I told him, ‘I don't know what's going on, but what's happening — I'm seeing with my own eyes that this isn't right.' ” He says he told the kid that when he got back to California, “I would let everyone know about this.”
He did. Candalario filed written statements with Arkansas child welfare inspectors, who investigated his and other reports of abuse, DHS documents show. The DHS investigators found credible evidence that the incident reported by Candalario had occurred, according to a summary of findings released under the FOIA.
The Lord's Ranch asserted that DHS “ultimately concluded that the allegations were ‘unfounded.' ” As proof, Bennett provided a document showing that the accused staff member had “no record of abuse” in the Arkansas Child Abuse and Neglect Central Registry.
But inspectors saw a pattern.
“Ranch staff consistently initiate restraint under circumstances in which no immediate threat to health or safety exists,” a licensing report summarizing inspections from November 1991 through May 1994 said. The inspectors concluded the Ranch was practicing “corporeal discipline” against Arkansas law.
Shortly after Candalario returned to California, Bud Suhl, in January 1994, blocked state inspectors from interviewing children about the abuse allegations.
The next day in Little Rock, Ted Suhl purchased several handguns, two AR-15 assault rifles, and two riot shotguns. The federal Bureau of Alcohol, Tobacco and Firearms reported the weapons purchase to the state. Next time, inspectors brought the local sheriff with them for protection, the state records show.
The Lord's Ranch said Ted Suhl's gun purchases were unrelated to the inspectors' visit. It said the dispute was not over whether children could be interviewed, but over how many children should have to speak with the investigators.
In the 1994 incident, “the investigator and the child care licensing specialist were demanding that the whole of the student body at the Ranch be lined up outside a room for interrogation,” former DHS child care licensing supervisor Joel Landreneau, the inspectors' boss at the time, said in written responses to Jacoby's questions. The ranch had a “legitimate concern” about these methods, Landreneau wrote.
Today, Landreneau is general counsel for the Lord's Ranch.
In May 1994, inspectors returned again. Bud Suhl angrily rebuked them. “He seemed to imply by his comments that we would be causing problems for ourselves by continuing to make unannounced monitor visits,” the state inspectors, Maurice Shirley and Gary Beckham, wrote in their report.
Shirley recommended that The Lord's Ranch's licensing status be moved to “provisional” while the allegations were under review.
Sometime not long after Candalario's stint at The Lord's Ranch, Huckabee, who was then lieutenant governor, visited the facility. A Baptist minister before going into politics, Huckabee "was very impressed with the work being done with the children," his spokeswoman, Alice Stewart, said in an e-mailed response to Jacoby's questions in 2008. DHS "at the time demonstrated hostility to faith-based entities," Stewart said.
The Suhls felt strongly about their mission. They “emphasized that all staff were Christians and are doing the Lord's work,” an undated memo in DHS files said.
In September 1996 state inspector Carolyn Winberry came across three boys “standing on the wall.” One of the boys wore a taped-together cardboard splint on his arm, Winberry wrote in a state report. He told Winberry that a few days earlier, he'd come to the aid of his brother, who'd been put in a “head lock” by another counselor. Staff had twisted his arms to restrain him. The boy “heard a ‘pop,' after which his arm ‘felt dead,' ” Winberry wrote. A knot appeared on his arm. The boy said it was broken, “but he was told to go to Bible class,” Winberry wrote in her report. Later the homemade splint was applied.
The documents do not show how the matter was resolved, and the names of the children and staff members involved were redacted for privacy reasons. The Lord's Ranch said the boy's arm had not been broken. “The patient was observed catching and haltering horses in the pasture one day after the incident,” the ranch said. It said, without offering documentation, that DHS had concluded the patient's allegations were unfounded.
Julie Munsell, a spokeswoman for DHS, said the agency could not comment on that allegation or others to protect the privacy of the children involved.
Huckabee became governor in 1996. The former Baptist minister put his Christian faith at the center of governing. "When people say, 'We ought to separate politics from religion,'I say to separate the two is absolutely impossible," Huckabee wrote in a 1997 book, "Character is the Issue.
In office, Huckabee worked with the Christian advocacy group the Family Council in Little Rock to identify evangelical Christians for appointments to state boards and positions. One of those was James Balcom, who ran a Christian home for abused and abandoned kids in Paragould.
In 1997, Balcom had approached his local legislator, Tim Wooldridge of Paragould, with language for a bill he wanted made into law, Wooldridge told Jacoby in a telephone interview in 2008.
Wooldridge at the time was an administrator of Crowley's Ridge College, an evangelical Christian school in Paragould. What Balcom wanted was quite extraordinary: To take licensing authority for children's mental health and foster care facilities away from DHS. The bill gave that authority instead to a new board, the Child Welfare Agency Review Board, consisting mostly of administrators of those facilities.
This bill — to have administrators of facilities govern their own business — became law under Huckabee. The new law also prohibited “interfering with the religious teaching or instruction” or the practice of “corporeal discipline” at children's care facilities.
As governor, Huckabee appointed the new board's members. He stacked it with evangelical Christians involved in foster care and children's mental health programs. One of his first appointments: James Balcom. In 1998, he appointed Ted Suhl.
The ranch's adversarial relationship with state inspectors changed after Huckabee appointed his slate to oversee children's care facilities. DHS employee Greg Gilliland, manager of the Arkansas Child Welfare Agency Licensing Unit, became the DHS liaison to the new board.
The ranch's adversarial relationship with state inspectors changed after Huckabee appointed his slate to oversee children's care facilities. DHS employee Greg Gilliland, manager of the Arkansas Child Welfare Agency Licensing Unit, became the DHS liaison to the new board.
Gilliland praised The Lord's Ranch. “I recommend the Lord's Ranch without reservation as an excellent resource for the care and treatment of troubled youth,” Gilliland wrote in a 1999 letter addressed to “Whom it May Concern,” which The Lord's Ranch provided Jacoby.
In another letter dated July 7, 2003, and released by the state under FOIA, Gilliland wrote to Suhl: “The Licensing Unit commends the ranch for the high quality of care and service you provide to troubled children.”
Gilliland declined to comment.
In 1999 the Child Welfare Review Board, with Suhl and Balcom as members, issued a state regulation banning gays from serving as foster parents. The American Civil Liberties Union sued. In 2006 the Arkansas Supreme Court overturned the ban as unconstitutional, saying the board didn't have the authority to issue the regulation.
The court cited testimony from Balcom that his religious beliefs were a factor in his decision to support the ban. “This testimony demonstrates that the driving force behind adoption of the regulation was not to promote the health, safety and welfare of foster children, but rather based upon the Board's views of morality and its bias against homosexuals,” the court said. Balcom didn't respond to requests for comment.
After Beebe became governor, he moved to end a rewritten regulation that prevented all unmarried couples from adopting or being foster parents. He said the need for foster parents was too great to limit the pool.
In November 2008, however, nearly a decade after the Child Welfare board first tried to stop gays from serving as foster parents, Arkansas voters completed the job. Voters approved a ballot initiative barring unmarried cohabitating couples from serving as foster parents, an effective ban on gay couples. It passed with lobbying from the Family Council. It is being challenged in court.
In January 2004, a matter concerning the Lord's Ranch came before the board. Board member Ted Suhl presented his problem to his colleagues: He'd hired a former Arkansas State University basketball player named Chico Fletcher to be a boys' counselor at the ranch.
But Fletcher turned out to have a court record of domestic violence. Suhl asked the board's permission to waive rules against staff with domestic violence records. Fletcher attended the board meeting with Suhl. He described the incident.
The mother of his little boy “told the police that I knocked my child out of her hand,” Fletcher said, according to a transcript. Suhl put in a good word for his employee. “I talked to him a long time and felt comfortable” before hiring him, adding that Fletcher had come “highly recommended” by his former basketball coach, Dickey Nutt.
“As with a lot of your staff, it looks like he can certainly handle the children,” said Huckabee-appointed board member David Whatley. Whatley is founder and chief administrator of Watersprings Ranch, a children's home staffed by “dedicated Christians” working through the “supernatural power of God,” according to its website.
The board quickly approved Fletcher's employment at the ranch, the minutes show. Suhl abstained from voting. No board member asked to review Fletcher's court records or speak with the ex-girlfriend, the minutes show. Fletcher no longer works at the ranch, Bennett said. Fletcher could not be located for comment.
It wasn't until the summer of 2006 that allegations of abuse at The Lord's Ranch became widely aired thanks to articles in the Times and Rep. Blair's legislative hearing.
Behind the scenes, there was more turmoil. DHS learned in May 2006 of allegations by an Alaska boy that he'd been sexually assaulted at the ranch by another juvenile. Ranch staff taunted him about the sexual assault, the boy said, and allegedly “told him that he was now ‘gay,' “ according to a May 9, 2006, DHS file memo.
The Lord's Ranch said the Alaska teen-ager had never made such allegations to its own staff and cast doubt on his story.
“Notably, the former patient accused a younger, significantly smaller boy of sexually abusing him,” The Lord's Ranch said in written answers about the incident report. “Arkansas DHS interviewed the alleged perpetrator and, in all likelihood, after visiting with him, concluded that the assault … was improbable.”
The Lord's Ranch did not address the allegation that its staff had taunted the alleged victim about being gay. DHS spokeswoman Munsell said privacy laws prevented her from commenting.
In the summer of 2006, Suhl summoned DHS Director John Selig to a meeting at Huckabee's office in the state Capitol, according to people with knowledge of the meeting. Huckabee didn't attend, but his chief of staff, Brenda Turner, did.
Suhl complained to Selig that his department's attempt to reform Medicaid spending would hurt kids, the person with knowledge of the meeting said. Selig and Turner declined to comment.
Bennett said the meeting wasn't held to “complain” about reforms but to “discuss proposed regulations that effectively would have restricted patient choice in mental health services.” He said Suhl was speaking “on behalf of numerous Arkansas mental health providers,” not just the Lord's Ranch.
In July 2006, as he laid the groundwork for his presidential bid, Huckabee touted his record against gay marriage and gay foster parents -- a record that the child welfare board had helped create.
Huckabee also campaigned in Iowa on Arkansas's gay marriage ban, approved by voters in 2004. Suhl's wife (using her maiden name) and a Suhl company had donated a combined $11,500 to a group lobbying for the gay marriage ban.
Huckabee's term as governor ended in January 2007, and he launched his campaign for president. His successor, Beebe, quickly moved to reform Medicaid mental health payments. “As a state, Arkansas has too many children in residential treatment for mental-health care,” Beebe said in a March 2007 news release.
Beebe appointed a commission to overhaul the system, stressing the need for more parental involvement and community-based treatments. Suhl, however, was well placed to benefit from the policy change: His family also owns Arkansas Counseling Associates, a provider of out-patient mental health services that billed the state $14 million in 2008.
Although the reform-minded Beebe was now governor, Huckabee's appointees on the Child Welfare board were still in place. In late 2007, they mobilized to defeat a proposal by state Sen. Sue Madison, a Democrat from Fayetteville, to make the board more independent of the facilities it regulated.
Madison introduced a bill to replace three of the children's facility representatives on the board with members of the public at large. “I thought that people [on the board] would be hesitant to censure a fellow board member for something going on at his facility, perhaps,” Madison told me.
Her bill also would have given this more independent board authority to subpoena records from the facilities it regulated. The proposal threw the Huckabee-appointed board into an uproar.
Its members held an emergency session to discuss how to defeat it, according to a March 13, 2007, e-mail from Charles Flynn, a board member and program director of the Arkansas Baptist Children's Homes. Flynn's e-mail to fellow board members and administrators of Christian children's facilities was forwarded to Madison, who forwarded it to Jacoby.
“Her questions indicate that she is beginning to understand more about how this system operates,” Flynn wrote.
Paul Schandevel, director of Children's Homes Inc. in Paragould, a Christian residential facility whose website says it provides “spiritual training” to troubled kids through daily devotionals and Bible study, responded to Flynn's e-mail. “It seems somebody thinks our current system does not hold us accountable,” Schandevel wrote.
“That board got real agitated when I filed that bill and they showed up down here [at the state Capitol] like crazy,” Madison told Jacoby. “I was immediately contacted by e-mail and phone calls.”
Her bill died in committee. “I just ran out of energy,” Madison said.
Beebe, however, was determined to take Suhl on. Around the same time, he moved to squash two measures in the state Senate known in the Capitol, according to columnist John Brummett, as the “Lord's Ranch bills.” The bills, sponsored by Suhl allies in the legislature, would have codified a preference in Arkansas law for institutional care, and increased reimbursement rates for providers.
While the measures would have benefited all providers of institutional care, Suhl was providing the “political muscle” for them, Brummett wrote. Beebe called provider representatives into his office — pointedly excluding Suhl, Brummett wrote. The governor let it be known he didn't want his hands tied by the state legislature as he moved to reform the system, and the bills were withdrawn, Brummett reported.
Matt DeCample, a spokesman for Beebe, said he had no reason to challenge Brummett's report.
The primary goal of the new Children's Behavioral Health Care Commission to reform mental health services: Give parents full participation in the treatment of their children.
Beebe spokesman Matt DeCample declined to comment on The Lord's Ranch. But he said: “We've instructed human services to fully and thoroughly investigate any complaints we get.”
Last year, DHS halted Medicaid reimbursements to another provider, Gilead Family Resource Center, after receiving a complaint about billing irregularities and medical practices at the McGehee-based facility.
The numbers of children receiving mental health treatment on an out-patient basis in Arkansas has increased substantially, from 36,661 in fiscal year 2005 to 48,322 in fiscal year 2008.
But the number of children in residential care is still more than 5,000 — 5,123 in 2008, up from 5,013 in 2005 but down from 5,435 in 2006.
Medicaid expenditures have ballooned. In 2005, the state spent $211,683,750.31 on mental health care for children 18 and under. In 2008, that rose to $392,210,831.
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