County Executive John Ladenburg takes exception to a recent scorecard on his claims of council wrongdoing when it suspended funding for the Prometa drug-treatment program.

In a Wednesday e-mail to The News Tribune, Ladenburg says the scorecard missed a key point: that the county’s performance auditors overstepped their mandate when they conducted a preliminary investigation of Prometa’s effectiveness. The council used that report as justification for suspending funding for the program.

In a response, Matt Temmel, the county’s performance audit coordinator, disagrees.

Read the full text of Ladenburg’s letter and Temmel’s response below.

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From John Ladenburg:

Dave, you miss the point. It was originally proposed that Matt Temmel and his staff look into whether or not the Prometa program should be the SUBJECT of a performance audit by experts. Temmel and his staff are not qualified to make any judgment regarding the effectiveness of a drug treatment program. No one thought they would come back with a report the TNT keeps referring to as a "performance audit" when it is nothing more than a layman's look at a medical drug treatment procedure. Instead of a staff report recommending whether we should or should not conduct a performance audit, then recommending appropriate and qualified experts to compete the audit, we suddenly receive a report that purports to analyze whether the drug treatment is working or not. Then, based on this totally unqualified report, the Council cuts funding for a program where the State is paying half the money and the University of Washington is about to conduct a real study. Again, it's not that we didn't expect some report on Prometa. We just didn't expect an evaluation because that is not what any performance audit has ever done before. Why was this one different? Some on the Council obviously knew in advance the report was not going to be a recommendation to conduct a performance audit, but was going to be an analysis of whether Prometa worked or not. The pre-determined budget amendment makes that clear. The Executive's Office certainly wasn't aware of it and that's why I was surprised by this last-minute budget cut amendment. I fully expected a report saying let's do a performance audit and some recommendation of a qualified auditor. That would have been proper. Cutting funding based on a quick analysis by unqualified staff is not.

Perhaps asking Temmel the right questions might get to the bottom of this matter. Ask him about the procedure for conducting performance audits. Ask him if he hasn't always been instructed to FIRST determine if a performance audit is warranted. If it is, ask him if he isn't then instructed to find a QUALIFIED EXPERT to complete the audit. In the seven years I've been Executive that's been the way it has worked. Ask him why he decided to complete his own audit even though he is unqualified do so and had never followed that procedure before.

Other than that, I thank you for finding the majority of what I said was true and correct.

John W. Ladenburg

From Matt Temmel:

David,

Your score card was well done, I thought. Thanks for passing on the Executive’s remarks. In response, I can offer a few comments.

1. The study was hardly “a full medical study of its [Prometa’s] effectiveness.” As the performance audit briefing paper says, “Only double-blind clinical trials can determine whether the patient improvement is a result of treatment or other factors, including the placebo effect.” (p. 19)

2. It is standard practice to conduct a pre-audit study to determine whether a performance audit is worth doing. The conclusion was that a performance audit would not be useful because only double-blind clinical trials can determine whether Prometa is effective. Further, in authorizing a pre-audit study on September 13, the Performance Audit Committee directed the staff to report in October on substantive Prometa issues, as listed on page 5 of the report.*

3. The pre-audit study, in reviewing the information available from the Pierce County Alliance and Hythiam, found many exaggerated claims, misuse of data, and an absence of baseline information for comparison against the Prometa data. The study also found that the Alliance had issued misleading press releases – for example, claiming that 86% of Prometa clients were drug-free 14 months after getting the Prometa infusions. Such claims were false, and we had a professional obligation to report it.

In passing the 2008 budget yesterday, the County Council made a decision not to fund Prometa treatment next year, but the state funding for Prometa treatment in the family drug court is unaffected by the Council’s action. The amount is $178,000 in 2008. At $5,000 per person, that is 35 Prometa clients next year, more than the Alliance served from family drug court in either 2006 or 2007.

The Executive’s comments suggest he is unfamiliar with other recent pre-audit studies conducted by my office. In December 2006, for example, I did a detailed substantive briefing on the growing backlog of Superior Court cases, and recommended that an audit contractor be retained. In October 2006, I did a substantive planning study on court reporters, and recommended that an audit was unnecessary. In early 2006, Bob Thomas did a planning study of Corrections overtime that addressed whether it is better to hire more correctional officers or pay overtime to the current staff. That study answered the big questions, which meant that a performance audit was unnecessary. (The TNT knows this report, as it is mentioned in Ian Demsky’s November 19 story on jail overtime.)

The pre-audit reports on jail overtime and court reporters are posted on the performance audit website: www.piercecountywa.org/performance-audit

Matt

*(1) Analyze evidence of Prometa’s success, including whether the available evidence meets industry standards. (2) Assess the risk to Pierce County as a result of being mentioned in Prometa’s advertising, including whether there is additional risk because the treatment may be research on human subjects. (3) Identify other jurisdictions that use Prometa and analyze their success rates. (4) Review the planned University of Washington study on Prometa effectiveness, including scope, research design, and status of the evaluation. (5) Assess whether Prometa is an effective use of county tax dollars.