GRAND MARAIS – The Cook County Public Health and Human Services Department (PHHS) spent approximately $500,000 for an adult client who was placed in an out-of-home placement setting for 273 days, though it should have been a fraction of that cost, an investigation that led to a massive overhaul of the department found.
“The costs were upwards of $50,000 per month, when normally inpatient care is closer to $4,000 per month…which led to expenditures of hundreds of thousands of dollars,” the investigation from July 25 states.
The investigation has been the subject of great public interest and led to the August resignations of several key officials in the Cook County PHHS department, including Alison McIntyre from her role as PHHS director and John Spieker from his role as behavioral health services and clinical manager. The investigation repeatedly cites a lack of accountability and mistakes made by Spieker and McIntrye in terms of billing, fiscal responsibility, and overall leadership.
“Many client matters have been mishandled by Spieker under McIntyre’s leadership, resulting in financial consequences to Cook County and potential harm to clients,” the investigative report states.
Kristi Hastings is a partner at the Fergus Falls office of Pemberton Law and led the investigation of the Cook County PHHS department following a series of complaints against the department that were filed earlier this year. Assisting Hastings was Dave Lee, the former public health supervisor in Carlton County. Lee served as the subject matter expert for the investigation into Cook County’s public health department. Lee’s name has been in the local news of late, as he was hired last month by Cook County to provide supervision and support to behavioral health workers within the county’s PHHS department.
Two redacted versions of the investigation reports – one from May and the other from July – into the county’s PHHS department have been shared with the Northshore Journal in recent weeks. The most recent, and much more thorough report, was sent Oct. 3 from County Attorney Jeanne Peterson. In addition to the resignations of Spieker and McIntrye, Merrisa Chapman and Dana Logan are also no longer with the county’s PHHS department as a result of the investigation, though the negligence of Spieker and McIntrye dominates the reports.
“Spieker’s behaviors, leadership, and supervisory style have caused direct harm to PHHS,” the investigation found.
The report continues, “Other witnesses interviewed, particularly those directly supervised by Spieker, consistently described him as a negative and toxic force within PHHS who would rebuff efforts to collaborate amongst teams and established a ‘my way or the highway’ persona. Multiple employees expressed a desire to leave Cook County employment or had already quit or transferred to a different team, due to a desire to distance themselves from Spieker.
“In a nearly two-hour interview with Spieker reviewing the weight of concern surrounding him and his performance, he took no personal responsibility. Instead, with each instance of concern, he explained that others were at fault, others had failed to inform him of necessary information, others had made mistakes, the circumstances were out of his control, etc.”
Beyond poor leadership exhibited by both Spieker and McIntyre, the amount of financial mismanagement cited in the investigation report is extensive.
“Spieker and McIntyre failed to actively hold staff accountable for their time entry, which has greatly impacted administrative reimbursement revenue,” the report states. “There is little accountability for revenue capture, follow-through on training, and overall critical management of expenses by McIntyre.”
With regard to the situation where the county spent approximately a half-million dollars on an adult client at the rate of $50,000 per month when it should have been a fraction of that cost, Cook County Administrator Kristen Trebil-Halbersma told the Northshore Journal that specific situation took place between October 2022 and October 2023. Cook County Auditor-Treasurer Braidy Powers and former Cook County Administrator James Joerke were both in leadership positions associated with fiscal accountability at that time.
“The financial supervisor provides monthly reports to the PHHS director (McIntyre) and the county administrator (Joerke),” Trebil-Halbersma said.
The financial web of how money comes and goes through a public health department is complex, and even more challenging to present in layperson’s terms. That being the case, local taxpayers often cite in public meetings and letters to the editor in the local newspaper that they have the right to know when things aren’t being done properly with their money. The financial components of the investigation and subsequent staff shakeup led, at least in part, to the public’s interest in the recent staff overhaul of the PHHS department. Equally as prominent is the role of the PHHS department, which is charged with doing work to keep residents safe and, whenever possible, healthy. And the work, according to the ethos of any reasonable government, should be done in a fiscally responsible manner. During the tenure of McIntyre and Spieker, these objectives were clearly missing the mark, according to the investigative findings.
“The morale in the teams that Spieker supervises is low, has a high rate of turnover, and has struggled with Spieker at the helm,” the report states. “Spieker lacks expertise in the programs that he supervises, and he does not engage professionally with his team. Spieker has poor relationships inside and outside of PHHS. Many employees repeatedly reported concerns about Spieker to McIntyre, and she took no meaningful steps to address or seek redress of the concerns.”
Moving forward, Trebil-Halbersma told the Northshore Journal she is optimistic the county’s public health department will be in a much better position for its staff and the people it serves, despite the recent challenges. The county is working with a service provider to provide support to PHHS staff, brought in the expertise and experience of Dave Lee for the behavioral health team, set up additional division meetings to communicate with PHHS staff, and hired a consultant to assist with the needs of the department, Trebil-Halbersma said.
