LONG BEACH, Wash. — Some employees from Willapa Behavioral Health are demanding a change in leadership after the firing of the mental health agency’s only primary care provider.

The termination of Dr. Dave Cundiff was a breaking point for more than a dozen employees. The move prompted some employees to pen an advertisement that ran in the Chinook Observer’s Aug. 19 edition. In the advertisement, the group alleged “erratic” behavior by CEO Adam Marquis and called for his removal.

In the past week, the Observer interviewed 10 former and current employees about working conditions at the agency since Marquis took the helm in July 2017. Some wished to stay anonymous because of concerns about possible retribution from Marquis and other leaders.

These employees described a CEO who was growing the agency too fast and without proper planning. One employee said they feared for their job as Marquis was “fond of telling people they are dispensable.”

The agency’s tax filings seem to back up employee concerns that the agency is having financial difficulties. Prior to Marquis taking over the agency, the Willapa Behavioral Health’s net revenue was about $200,000 per year for 2015 and 2016. After Marquis became CEO in 2017, revenue dropped to about $35,000.

Two board members resigned this month, including the previous board chairman, Long Beach Police Chief Flint Wright. He left the position because he was tired of the “never-ending controversies.”

“I have enough stress in my life and I don’t need any more,” Wright said.

Dennis Long resigned for health reasons. Long was the former president of the Bank of the Pacific and is a Pacific County Fire District No. 1 Fire Commissioner.

Three new members were brought on board, all from Oregon, including Norm Stutznegger, the new board chairman.

The Observer made repeated attempts to speak with Marquis, who refused to set up a time to talk by phone. The newspaper sent questions by email to Marquis, who did not respond.

The newspaper also attempted to reach the agency’s board. Stutznegger did not respond to the Observer’s emails.

New model of care

Willapa Behavioral Health is a nonprofit organization that began operating in Pacific County in 1986. The agency provides mental health services, substance use disorder treatment and, in 2019, began offering psychiatrically sensitive primary care.

To lead the new model, Marquis hired Cundiff as a primary care physician.

To help people understand what he does, Cundiff asks them to remember a time when they were in severe pain. Then, he asks them to remember how it felt when they were told the pain was not life-threatening. He poses the question, how did that change how they thought about the pain?

Every physical pain comes with a mental and emotional interpretation, which is different for every person, Cundiff said. What his model of primary care did was treat physical symptoms, in consultation with mental health counselors and psychiatrists.

Not all of his patients sought treatment for mental health-related physical concerns, Cundiff said. But the ones who did often had past traumas. Many were nervous about seeing a new provider. This meant initial visits often took time, Cundiff said. It could take up to a half hour for patients to feel comfortable with Cundiff, and even longer for them to open up about their physical concerns, he said.

When Cundiff began working at Willapa Behavioral Health, he scheduled new patients for two-hour appointments and booked 30-minute follow-up appointments. This gave him time to listen to his patients. However, insurance doesn’t reward doctors who take their time.

“Communication is the foundation of safety, and nobody pays for it,” Cundiff said.

In July, Cundiff said, Marquis demanded he shorten his appointments. New patient appointments would be 30 minutes, and follow-ups would be no more than 15 minutes. Cundiff said he did not want to shorten appointments. Marquis asked him to try it for a day and, without consulting Cundiff, ordered the appointment times changed, Cundiff said.

Cundiff refused to see patients under the new appointment times.

“I was terrified,” Cundiff said in an interview with the Observer. “We weren’t ready for safe care at that speed. We also weren’t ready to deliver a quality patient experience at that speed.”

The 15-minute appointment is not unusual in a primary care setting. The federal Centers for Medicare & Medicaid Services reimburse a primary care doctor the same for a 10-minute visit as they do for a 25-minute visit, according to the 2019 Medicare physician fee schedule. It is more profitable for a doctor to see three patients for 10 minutes each than one patient for a 30-minute visit. Many private insurers mimic this model.

But Cundiff wasn’t supposed to be operating under a normal primary care model, he said. Willapa Behavioral Health was trying something new. At minimum, it required Cundiff to take more time with patients.

“The quality of the patient’s experience is a foundation for effective care,” Cundiff said. “We can’t help patients much unless they trust us. Patients won’t trust us if they don’t feel cared for. That is important for every patient, and it’s especially important for patients who come to us traumatized and scared.”

Cundiff continues to worry about his patients, he said. Because of how his termination was handled, he said, there wasn’t time to give his patients adequate notice of the change in care.

Cundiff’s contract was set to expire next July, according to a copy of the contract he provided to the Observer. In the contract, it does establish a productivity requirement for Cundiff of 60% billable hours with clients. In Marquis’ email terminating his contract, Marquis mentioned an alternative model was presented to Cundiff for a flat-fee reimbursement per patient. This alternative, Cundiff believed, would have made him an island in the agency, working without the collaboration of the mental health providers.

Cundiff didn’t believe the alternative was offered in good faith. He lost trust in Marquis, he said. Cundiff also offered his own alternative, which would have reduced his salary until primary care became profitable. Marquis did not accept this proposal.

Profit pressure

Prior to Marquis joining the organization, Willapa’s finances appeared stable, according to IRS filings. The agency showed an average net revenue of about $200,000 for the years 2015 and 2016.

Marquis joined the agency in July 2017. That year, net revenue dropped to $35,000. In 2018, Marquis’ first full year as the agency’s CEO, the agency had a net loss of $100,000.

When Marquis joined the agency, he expanded services, opened new locations and hired more staff. IRS filings show in 2016 the agency had 66 employees. By 2018, the agency employed 84 people.

Marquis’ concern about Cundiff’s time was based on his strategy to get a higher reimbursement rate, which required the agency to have at least 50% of its service encounters be for primary care.

Despite concerns about finances for basic services, which led the agency to create productivity goals for the agency’s health care providers, Marquis still wants to expand.

Earlier this year, Marquis secured a grant for $25,000 to do mobile medical outreach. His plan was grand. The mobile outreach would go to homeless camps, low-income areas and do medical evaluations and treatment. However, the medical team was given just two weeks to stand up the project.

After medical staff explained they would need more money, staff and time, Marquis told them: “I don’t want to hear why we can’t do this, I want to hear how we can do it,” said one employee familiar with the situation.

Marquis did eventually accept a scaled down operation of mobile outreach. He rented an RV and a staff member went around the community signing people up for Medicaid.

“He has good ideas, he just doesn’t get how to do the follow-through appropriately,” the employee said. “And he doesn’t include the people who would know how to do it appropriately.”

Low morale for some

The former and current employees who volunteered information about what it was like to work for Willapa Behavioral Health under Marquis acknowledged there are some employees who do not feel strongly about removing the CEO. There is a lot of turnover at the agency, they said. Many people have not “marinated” in the place long enough to be concerned about his leadership, one employee said.

However, in 10 separate interviews , each reported a similar pattern of bullying and unpredictable behavior by Marquis.

Several reported seeing co-workers leave in tears after being confronted by Marquis. Sometimes these confrontations would happen in front of the employee’s peers. One employee said the best way to describe Marquis’ body language when he got angry was “seething.” One employee said Marquis would later apologize, but would excuse his behavior by saying his anxiety got the better of him.

Several of the employees had more than 10 years of experience in the behavioral health field. These employees said they’d never been treated the way Marquis treats them.

Every employee who spoke to the newspaper stressed how much they enjoyed their work. One called the work they do essential to the community.

Because of how essential it is, one employee said it is concerning that Marquis doesn’t focus on details and is placing the agency in a precarious position.

“We’re a house of cards, we’re not on a solid foundation,” the employee said.