On Tuesday, County Behavioral Health (Mental Health & Substance Abuse) Director Dr. Jenine Miller gave the Supervisors a “Specialty Mental Health Services Presentation,” which was essentially a sales pitch for Camille Schraeder’s Redwood Quality Management Company’s anchor contract of about $17.4 million.
RQMC is referred to by Dr. Miller as an “ASO,” or Administrative Services Organization — Mendo has a Mental Health Department with administrative responsibilities, then they contract with RQMC for another layer of administrative services, which in turn subcontracts with several dozen non-profits and organizations in the County to provide the “speciality services.”
And, like the ocean slowly reclaiming Miami, the human misery outside the Ukiah windows of all these layers of well-paid paper shufflers, is ever greater, job security for even more doers-of-good.
When the Ortner Management Group (OMG) had the ASO contract for adult services back in the mid-2010s, the County paid consultant Lee Kemper $40k to do an audit of Ortner’s work and the County’s contract with Ortner. Among other things, Kemper criticized the County’s contract with Ortner for a series of “weaknesses” in the expectation that a “mid-course improvement” could be made based on Kemper’s widely praised report and recommendations.
Those “weaknesses” included a lack of clearly defined deliverables, goals, objectives, timelines, and performance metrics, and an associated lack of penalties for non-compliance. In other words, Ortner was sucking up millions of public dollars with no accountability whatsoever. The Pentagon and its defense contractors never had it this good.
Kemper recommended quarterly reviews of service delivery and “clinical oversight” of ASO subcontracted facilities.
Kemper also recommended that the CEO specify when “independent financial audits” of the ASO should be conducted and the timing of those audits.
Soon after that Kemper report in 2016, Mendo canceled its contract with Ortner and gave the adult mental health services contract to RQMC, which already had the under-25 mental health services contract.
Since then there have been no “independent audits,” no “clearly defined deliverables, goals and objectives,” or performance metrics developed or measured. The Schraeders are a private business, and as Ms. Schraeder herself once challenged the Supervisors, quoting from memory, “If you don't like it, you take care of all these [reimburseable] people.”
According to Tuesday’s presentation, the State Department of Health Care Services does a “triennial” mental health plan audit and some other mystery state agency does an “external quality review” every year. The results of those limited reviews were not mentioned in the presentation.
Yet, year after year, RQMC continues to be given no-bid, sole source contract renewals with minimal comment or review.
In his first year as Supervisor, Ted Williams called for breaking up RQMC’s huge contract into smaller pieces so that the County might attract competitive bids on some if it.
That never happened, of course.
Williams also asked several times for “performance data,” and “outcome measurements,” as did the City of Fort Bragg with a formal letter to the County. No such data was provided. Fort Bragg’s letter went unanswered. After several more requests, Williams gave up, saying that he had “capitulated” in the face of staff’s refusal to provide outcome information.
With this background, Dr. Miller and Ms. Schraeder may have felt that the Supervisors and the public needed a little PR boost in order to keep the lucrative contract renewals coming. We say PR because the exercise was entirely unnecessary; there was never any question about the Board renewing the contract.
Accordingly, Tuesday’s “Speciality Mental Health Services” presentation contained Dr. Miller’s attempt to provide some mental health service statistics, which she hoped would mollify critics and convince the Supes that RQMC deserved this latest $17.4 million contract renewal. (RQMC has several other associated helping and homeless service contracts, which brings their total contract value to over $20 million.)
The Presentation said that billing disallowances were way down since Ortner left Mendo, that Mendo’s “claims per beneficiary” at an average of about $7400k per client were higher than the state average — there's gold in these people! — that “rehospitalization rates” (Post Psychiatric Inpatient 7-day follow-up) were very low, that the time to get a psych appointment was down, that crisis assessments were up, that persons getting meds were up, and that the number of adult clients showing a decrease in impairments (“per ANSA scores in FY 19-20”) based on comparisons between intake and six month intervals were fairly high at 86%.
In addition, a small parade of mental health system contractors and insiders (eight of them, by our count) all praised RQMC for their mental health services.
Apparently not satisfied with the information in the Sales Pitch, Supervisor Williams repeated his request for outcome information. Supervisor Dan Gjerde suggested it would be good to know how many clients had repeated contact with law enforcement.
After agreeing to form yet another ad hoc committee to try to figure out exactly what mental health “performance metrics” should be developed or provided — nobody had any idea what they might be; the contract still doesn’t have such requirements despite Kemper’s recommendations — the Board voted 4-1 to approve RQMC’s $17.4 million contract renewal, Williams dissenting.
As a possible starting point for the ad hoc committee, before she moved to Arizona, Anderson Valley resident and retired senior mental health staffer Beverly Bennett told us that one of the best ways to measure the effectiveness of mental health services was to see how many discharge plans were written and then how many of them worked out with no more problems such as crisis calls, hospitalizations or law enforcement contacts.
Meanwhile, absent an independent audit or more granular performance information, Mendo is again left with taking the word of the people getting the money that they’re doing a decent job with it.
PS. It was interesting to see in the latest CEO report that the County’s Mental Health Department has 60 slots, 33 of which are filled. 12 are in recruitment. They had only 2 new hires, and 5 separations in the last year. Yet, the Mental Health department — in fact the entire Health & Human Services/Social Services apparatus, the County’s largest single department — isn’t even listed on the recent budget versus actual budget status report because that report is limited to General Fund departments only.
Besides the lack of meaningful performance data, does anybody track the HHSA budget?
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RQMC’S $17.4 Million Mental Health Contract
“the Board voted 4-1 to approve RQMC’s $17.4 million contract renewal, Williams dissenting.”
Supervisor Williams: In response to good faith requests for aggregate patient outcome documentation, it’s been suggested Supervisor Williams go pound sand. I voted against the contract perhaps for the same reason my colleagues supported it: our county has fueled a monopoly. Outcome data has been as elusive as bonafide negotiations.
Sadly Despite the Mendocino County Voter's approval of Measure B. It appears that after receiving several year's of the Measure B tax proceeds very little has changed and Mental Health Services continue to be a monopoly that lacks any accountability. Our Elected Representatives have failed in their promise to Mendocino County Residents.
Measure B was run without a financial analysis. All sorts of promises were made, most which cannot be satisfied with the money raised. Recent board direction to construct a Psychiatric Health Facility will likely consume the remaining revenue.
ms notes: That — the PHF will likely consume the remaining revenue — does not need to be the case. If Supervisor Williams and the County had pursued the Adventists’ offer to provide a PHF, at least in the interim, there wouldn’t be a need for a new facility built to hospital specs. But CEO Angelo, on her own, declared that developing the Adventist option “wasn’t in the public’s best interest” and none of our elected officials questioned that presumptuous unilateral claim by one senior unelected official. Further, there’s been no discussion of facilities with fewer than 16 beds because Dr. Miller says that’s the way to maximize billing and bring in clients from outside Mendocino County. For all his rhetoric about needing data and supporting information before making big decisions, Supervisor Williams has not provided any supporting information for his claim that “a Psychiatric Health Facility will likely consume the remaining revenue” — unless, of course, he has no interest in pursuing less expensive options.
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Owner Of Mendo's Mental Health Monopoly Speaks
(Re: complaints about a lack of outcome information)
Outcomes were presented. Hospitalizations, Individual client improvement measures. Homeless mentally ill housed etc. That said, more client centered information importantly while managing privacy is good .
RQMC is a Network provider. This is by definition a single agency/county partnership supporting many direct care providers most importantly our in-county/local providers who live and serve, as well as the hospitals, treatment centers, and others who serve our vulnerable people out of county.
There is much to be proud of in our County and in the information shared as it relates to other Counties, data publicly reported is exemplary. Having said that…
The reason the network of care exists is to support and improve the lives of those suffering a mental health concern. Primarily medi-cal beneficiaries of high acuity and crisis support for all.
It is a good thing that as a community we all care about our people and the services they receive.
Any specific data requests have and will be explored and reported. Thank you so much for the care and attention our communities have for our people .
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Supervisor Williams Replied:
It has been approximately two years since you, Supervisor Gjerde and I sat together to discuss my request for comparative outcome data. Nada. In my experience, as soon as a multi-million dollar contract is approved, there is no follow up.
Since our Monday night call, where you threatened to "walk" if I voice any criticism about Redwood, I contemplated whether this is an appropriate negotiation dynamic. Do other Supervisors receive this treatment? Is this how business has been conducted historically? I have concluded it is not tenable and culpability is with government, because we have fueled a model devoid of competition. Either we say yes to a $17M contract or we fall short on mandated services and place a vulnerable population in peril. This is not a negotiation. It's a rubber stamp under a checkmate of handcrafted circumstantial duress.
Employees at Redwood and the assortment of providers work hard every day and I believe there are success stories. I also believe you care deeply about the clients. I find the overall structure to be against the long term interests of the public. You likely have board majority support, because no other options exist, but I won't be silenced. I'm interested in patient improvement, not checks or prescriptions written.
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Maybe Ms. Antle Can Have A Look At Redwood Quality's Books
(ms notes: A minor typo at the County Garage (a department of the Executive Office, not the Sheriff) concerning vehicle mileage somehow morphed into an implication that the Sheriff had overstated his patrol vehicle mileage in his budget request for replacement vehicles. This in turn lead to Supervisor Williams posting on facebook: “$53k vs $2k, your public money. This might have been caught with an audit.”)
While meeting with the Executive Office staff last week, it was brought to our attention that there was a significant discrepancy between the EO’s calculation of the number of reported miles driven by the Sheriff’s Office patrol vehicles during the fire events and the miles noted on the Garage’s billings paid by the Sheriff’s Office. After the meeting, the Sheriff’s Fiscal Manager instructed her staff to audit the Garage’s billings line-by-line during that time period to check for any mileage discrepancies. When the September 2020 Garage Billing was compared to subsequent and previous months, an odometer error was noticed for SO Vehicle 23-503. The ending odometer reading was recorded on the billing as 154,707 miles when it should have been noted as 58,707 miles (a difference of 96,000 miles). Journal entry for this billing was consequently in error and resulted in the Sheriff’s budget being overcharged $50,000. The Sheriff’s Office relied on the mileage data supplied in the Garage Billings to relate information about patrol vehicle usage during the fires. This was in error and it should be noted that there were 96,000 less miles driven than originally though in the month of September (original mileage quoted was 200,000 miles). Total Garage mileage billed for September compared to the correct mileage charges are shown in the charts below:
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From: "Darcie Antle" <firstname.lastname@example.org>
Date: June 25, 2021 at 9:36:42 AM PDT
To: "Carmel Angelo" <email@example.com>
Subject: Re: Garage Billing Error.docx
SO [Sheriff’s Office] reported they put over 200K miles on vehicles during the 2017 and 2020 fire. Apparently they based this on a bill from garage for 100K miles. Garage had a billing error, either a data entry by a deputy at the pump or by the garage billing for fuel. The SO never audited the large one month bill. At the budget meeting with Undersheriff and Juanita, I stated my records from 214 reports only support 20K miles per each event. So if they actually did 200K miles we have a documentation error with deputies. That prompted Jaunita to go back and review the garage billings. (which by the way should be done each month)
* * *
Sheriff Kendall replied:
Good afternoon Darcie. You were correct when you indicated the mileages didn't match the 214's you had been provided from the Oak and August Complex. Juanita provided me with the attached details, explaining after she had met with you, she had staff go line by line to see where the discrepancies were. We will continue to go over these and see if there are any other mistakes. The discrepancies reported to us by the garage (which appeared to be some type of a typo) were off nearly 100K miles. I will need to advise the board and the public as we had reported this out based on the wrong mileage numbers we had received for billing.
Matthew C. Kendall
Mendocino County Sheriff's Office
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The Press Democrat ran a report on Sunday ranking crops by water usage. According to the PD’s chart, pasture land (at about 5 acre feet per acre per year) drank the most agua, with almonds and pistachios, alfalfa, citrus/subtropical fruit, sugar beets, other fruits, cotton, onions&garlic, potatoes, listed as the top nine water users in the state, with vineyards coming in at number 10 with almost 3 acre feet of water per acre of crop per year. Oddly, the PD didn’t list rice, a big water consumer.
PD Reporter Matt Pera added, “Many people also question how much water cannabis takes to grow. The Department of Water Resources didn’t track water usage for cannabis in its 2015 data, but The Washington Post reported in 2015 that the crop uses 1.4 acre feet per acre.”
Apparently, the PD wants us to think that wine grapes are not a major consumer of the Northcoast's finite, and diminishing, supply of water.
But the PD left out a few considerations.
Most of the crops they list are not grown in significant volume on the Northcoast, making the PD’s list nearly irrelevant to their readership. Acreage of the crops wasn’t mentioned — but grapevines are planted very densely in vineyards these days to maximize yield per acre. Vineyard rootstocks have been bred by the specialists at UC Davis to be water dependent, with shallow roots making them hard if not impossible to dry-farm. And perhaps most significantly, frost protection water wasn’t mentioned.
According to Mendo’s latest crop report, Mendo has almost 17,000 acres of wine grapes, most of them in the parched Russian River drainage. Everything else is piddling: Apples, 216 acres. Pears, 1100 acres. Miscellaneous: 245 acres. If you think “pasture” is a “crop,” like the PD does, then you might factor in Mendo's 3,500 acres of “irrigated pasture” at about 5 acre feet of water per acre per year.
Using the PD’s vineyard water usage numbers of about 3 acre feet per year per acre of vineyard, we get a vineyard usage total of around 45,000 acre-feet per year. Add frost protection — not all grape growers have gone to frost fans which are typically set abuzz in dry years — and you get a much bigger vineyard number.
In 2019, the last year Lake Mendocino got any decent rainfall, the lake level never got above 50,000 acre-feet. We’re not likely to see it get over that in the future unless we get an unusually high rain year.
So roughly speaking, Mendo grapes use the equivalent of more than all the water stored in Lake Mendocino every year, more depending on how much frost protection water is factored in. Of course, not all the Lake Mendocino water went to grapes — a lot of inland Mendo grapes got free water from Ukiah’s government paid-for purple pipe recycled wastewater project.
It’s difficult to know how many “acres” are planted in pot, of course. The legal limit at present is about one-quarter of an acre. In some parts of the County, mainly north of Willits where there aren't many grapes — pot is probably the biggest water consumer, combining legal (which is very small) and illegal which is larger. But even then, we’ve never heard of pot gardens which are hundreds of acres in size like vineyards. So pick your number for pot water — it’s not going to get anywhere near grapes.
Therefore, in terms of “crop water usage” it’s misleading to use the PD’s method of water consumption ranking which implies that grapes are low water users — per acre per year.
That should come as no surprise since the PD is the recipient of lots of wine ad dollars and is joined at the hip with “wine prince” Dominic Foppoli and his fellow wine industry magnates in Sonoma County.
IN A RECENT NOTE responding to former Supervisor Carre Brown’s claim that “We have enough checks and balances on water,” when we obviously don’t, we said in passing that “since there are no gages on inland wells and, until recently, Potter Valley grape growers and ranchers can have as much essentially free water as they want from the Potter Valley Diversion there’s no real checks and balances to provide.”
A POTTER VALLEY READER quickly complained that we were incorrect in using the term “essentially free water,” because he pays hundreds of dollars a month to the Potter Valley Irrigation District for his water. We knew that, of course. But the Potter Valley reader claimed that we had made such an egregiously offensive statement that he was forced to use crude language to try to refute it.
THE POINT we were trying to make was that the Irrigation District does not pay for the Eel River water they get from the Potter Valley diversion. But the District’s customers of course pay for the delivery and administration of the water. The distinction is important. If the Irrigation District doesn’t pay for the diverted water itself, there’s no incentive for the District to conserve or plan ahead since the more water they sell the more money the District makes. Since we couldn’t find a breakdown of the Irrigation District’s finances we don’t know how they determine the rates they charge.
MENDO’S LOCAL Area Formation Commission (LAFCO), which is supposed to review all special districts in the County periodically, has no record of a Potter Valley Irrigation District review, although it should be on their list of reviewed districts. The Potter Valley Irrigation District's own website has no financial breakdown, nor does it have a record of an audit which is usually required of special districts. It doesn’t even have a clear statement of rates. Their Board Agenda packets list “financial reports” as a subject, but they do not post the “financial reports.” Nor does the Irrigation District post required meeting minutes.
THE DISTRICT does mention that it has a “reserve fund” for maintenance and construction projects, but again no information about how much is in it or what “construction projects” it may be used for. Normally “reserve funds” are not for maintenance, but for capital improvements. However, the District does not list any capital improvements. If the District had an arrangement to pay for the diverted Eel River water they might have been able to use some of that accumulated money for storage projects which, if they were even minimally farsighted, they might have used to prepare for predictable water shortages. It is therefore fair to say that Potter Valley has become highly dependent on the free water from the Eel as Potter Valley has grown over the years well beyond simple pasture and farming into larger and larger water-dependent vineyards. It’s unlikely the vineyards would be there if they didn’t have access to the large volumes of cheap water they get from the Irrigation District.
THE IRRIGATION DISTRICT is overseen by elected directors who are themselves customers of their own District: Eugene McFadden (grape grower), Ken Stroh (rancher), Janet Pauli (grape grower), Jim McMenomey (hay grower), and Mac Magruder (cattle rancher). This creates an awkward arrangement where the Board has to establish water rates for themselves, as well as their other customers. Let’s just say, they’re not likely to overcharge themselves. But as supplies dwindle, the District’s fixed overhead cost has to be spread over smaller and smaller amounts of delivered water raising the cost per unit.
IT’S UNFORTUNATE that discussing these contorted, inefficient and self-serving political arrangements in Potter Valley and elsewhere in the Russian River watershed cannot be conducted sensibly. Like her Potter Valley predecessor Mike Delbar, former Supervisor Carre Brown did her darndest to make sure nobody messed with Potter Valley water and the diversion, angrily snapping like she did most recently at Jim Shields and other occasional diversion critics.
For his part, current Potter Valley Supervisor Glenn McGourty (who does not live in Potter Valley, we know, we know; and who is a grape grower himself) is continuing in that spirit, albeit more cordially. For example, on the recent Tuesday morning County water roadshow in Anderson Valley, in answer to an audience question about metering, McGourty tactfully dodged the question, saying that metering wasn’t required because his on-paper-only “Ukiah Valley Sustainable Groundwater Agency” is working on “modeling” Ukiah Valley water usage — a guessing game project that will never end and which will scrupulously avoid determining how much water is actually consumed by the biggest users in the Russian River watershed.
* * *
Measure B Committee Attempts Seppuku, Fails
by Mark Scaramella
Deputy Ukiah City Manager Shannon Riley opened the June 23 Measure B committee meeting with her blunt assessment of the committee’s current role: “This committee is required by the Measure that the voters approved. So we need to exist in some form. My interpretation of the text of the measure is that we can be a fiscal oversight body. We have comparable committees in the city of Ukiah who oversee the sales tax measures. But the problem is, the only way we can effectively do that is if we have a tool to measure it against. Right now those tools are not in place. We don't have any spending authority of our own. Only the Supervisors do. They directed that we use the Kemper report as our strategic plan. But I think there was pretty general agreement that the financial component of that report probably needs a second look. It may not be completely accurate. Without anything to compare the work that's being done against, I don't even know how we can be a fiscal oversight committee. It would involve the support of the supervisors, for sure. But at this point they seem pretty intent on getting the PHF [Psychiatric Health Facility] done and furthering a couple of specific projects. I don't really know what role we can provide in this scenario.”
After some of the usual irrelevant committee discussion the Measure B committee specializes in, Riley continued: “The Board of Supervisors kind of just made their own decisions about moving forward with the PHF, adopting the Kemper report as a strategic plan as is. At this point the Measure B committee is either just a rubberstamp or a scapegoat. I don't believe we are serving any functional purpose here other than, if anything, slowing things down. I believe we could better serve the process for the voters by becoming more of a fiscal oversight group that meets on a less regular basis simply to compare the strategic plan to the work that is actually completed and through the independent audit. Unfortunately, the things that need to be in place to effectively and transparently function are a strategic plan and a financial plan associated with it and an independent audit. We don't have either of those things.”
More irrelevant discussion before Riley added: “The criticism is not that the money has not done anything. But rather that this committee hasn't done anything. County staff and the supervisors have put Measure B money to work. But how effective has this committee been In facilitating or implementing that? That's the discussion that we are having here. We need to use this money more transparently, more effectively, and more efficiently. I don't think this committee is helping that, through no fault of our own [sic]. We tried something. This was new. There is no other agency or county that I know of with this kind of funding system. We thought the system would work, and it is not. We have to figure out a way to make it work better. We are three-fifths of the way into the collection of the money and we have two more years to collect that half-cent sales tax. So we need to be as efficient as possible.”
The question Riley was trying to answer was — Should this aimless, irrelevant committee continue regular meetings, and if so how often?
Supervisor John Haschak, who appointed himself to the Board of Supervisors Ad Hoc Committee a few months ago, went zen: “How do you know how many meetings you should have if you don't know what the meetings are for?”
Ah so, Supervisor.
Haschak then tried to express what the meetings were for, and failed, even by Mendo's low-bar rhetorical standards:
“We talked about the purpose and the strategic plan and the fiscal plan. We are seeing a lot of things being done. I just went by the CRT [Crisis Residential Treatment Center next door to the Schraeder’s Redwood Community Services offices on Dora Street in Ukiah] and it looked beautiful. It is being built. We are going ahead with a PHF. We are doing the MOPS [Mobile Outreach, an obsolete term; the current term is Mobile Crisis Response Unit, much more than just “outreach.”]. The awareness and education program. The aftercare program. We should keep an eye on those things. When we look at the budget overall, do we have a plan besides the year-to-year budget about how we are going to spend the $25 million? We have heard about the PHF costing between maybe $8 million for renovating a project [sic, we have no idea what Haschak means by “renovating a project”] up to $25 million for redoing Whitmore Lane. Where are we between those two numbers? $8 million and $25 million? If we don't have a plan for controlling this money, decisions as to what we want to do with the Measure B money, we are going to spend the $25 million and that will be it and we will have to do reflooring [sic] or something else. There is a big role for the Measure B committee watching how this money is being spent, helping make those recommendations as we go along because what is it going to be? $8 million? Or $25 million? For this PHF. What are the priorities? If we had a big picture of a strategic plan with priorities we might say, Hey, we want the $15 million PHF and we want to spend the remaining $10 million on other programs. I hope the committee can keep working on these issues and come up with a fiscal plan for it all.”
Obviously, the Measure B committee has demonstrated that they are totally incapable of “coming up with a fiscal plan,” or even a lunch plan, and don’t even want to try. Further, the question of how much money will be spent on the PHF is out of the Measure B committee’s hands and out of the Supervisors’ hands. CEO Angelo — who later in the meeting made her remark about there never being enough money — has already declared that the cost of the PHF will be at least $25 million, despite a few lingering questions about how to make sure it’s all spent on the PHF.
Riley replied: “Yes. How do we know how often we could meet if we don't know what we are doing? We had an agreement in place that we could have had a strategic plan and a fiscal plan in place by May and restructure this committee.”
(Note to Ms. Riley: Strategic plan is a redundancy, especially in the county where neither plan nor strategy has been seen in years. And the new one the Supes are paying $75k for or more will not help in the slightest. Look who’s doing it.)
The “agreement” Riley refers to was in the minds of a few Measure B people, but no one else.
The intrepid Riley plunged on. "But with all due respect to the supervisors, they plowed ahead with other plans and went in a totally different direction. I would like to reconvene our ad hoc committee on that and see if we could get to some resolution. But most of these projects have already been committed to. It's a little [sic] cart before the horse. This group is not in my opinion -- and no offense to any of the intelligent, qualified people on this committee [sic] – but we are not having a meaningful impact and no work is being done.”
Without much to go on or anything else to do, the Committee then voted unanimously to move to every other month meetings with an eye toward quarterly if no new tasks for them to do nothing about arise. Since nothing will arise, the Measure B Committee can move to yearly, then once every ten years, to meet the minimum requirement of the original Measure B text.
After years of debating things like what kind of light bulbs should be installed on the training center and two failed attempts at hiring a project manager, no one cares what they do anymore.
PS. Discussing the PHF and associated plans at the Measure B Committee meeting on June 23, CEO Carmel Angelo went existential, fairly shrieking, “There will never be enough money! Never! Tell me how we’re going to have enough money. There’s no way. By the time we’re done with the Training Center I don’t know how much that’s going to cost. Should we remodel Whitmore Lane for the PHF? Or should we buy a piece of land and build from the ground up? The cost of an acute psychiatric facility 24/7? There’s not enough money in the world! In the end, three years from now, five years from now, ten years from now — there’s NEVER going to be enough money.”
THEN the CEO contradicted her own top staffer, Mental Health Director Dr. Jenine Miller, who has said all along that the PHF operations would be funded out of existing Medi-Cal and other insurance funding streams because they only accept reimburseable clients. Angelo implored the committee to do everything they can to “mitigate” the impact of the PHF operations on the General Fund. (At present the entire Health and Human Services budget isn't even listed as a General Fund department on the County's latest budget report.)