Amidst controversial ousters and resignations, Orange County Supervisor Janet Nguyen Tuesday solidified her grip over CalOptima, the county’s $1.4-billion managed health care program for the poor and elderly.

But there are mounting questions about the stability of the agency that Nguyen is seeking to remake.

During a special Tuesday afternoon meeting at the agency’s headquarters in Orange, board members voted for the ouster of Ed Kacic as board chairman. Kacic openly confronted CalOptima General Counsel Gary Crockett over the legality of the meeting.

Crockett publicly maintained that recent meetings have been in full compliance with the state’s open meeting laws.

In the meantime, county Health Care Agency Director Mark Refowitz was unanimously elected to take over as CalOptima chair. Lee Penrose, president and CEO of St. Jude Medical Center, was elected vice chair.

New board appointees were visibly nervous about the situation they have inherited. Refowitz publicly declared he hoped his reign would be the shortest in history.

Tuesday’s vote came after the resignation of CalOptima Vice Chair Jim McAleer, who wrote to county supervisors this week saying he was resigning in protest because of the instability created at CalOptima by Nguyen’s jockeying for control.

McAleer also alerted county supervisors to a pattern of violations of the state’s open meetings laws, noting that Crockett was calling meetings without consensus from board members.

Other CalOptima board members, including Kacic and Mary Anne Foo, also questioned how Tuesday’s meeting had been convened.

“I’m confused about today’s meeting,” said Foo, who runs the board nominations committee for offices such as chair. “I never got a call.”

In an interview late Tuesday, McAleer took direct aim at Crockett, saying he had pressured McAleer to not forward his concerns to the county grand jury.

“I expressed reservations about Brown Act violations to CalOptima internal counsel Gary Crockett, and he called me and said my option was to go to the grand jury. But he recommended against it, because, he said, they could look too deeply into what has happened, and once you open the door you can’t close it. I pushed back, and he said I should really be careful about taking that action,” McAleer said.

McAleer, who serves 70,000 families as executive director of the Orange County Alzheimer’s Association, was universally praised Tuesday both by county supervisors Chairman John Moorlach and a majority of CalOptima board members, including Nguyen, for his service and professionalism.

Yet McAleer said supervisors have essentially allowed the agency to be dismantled.

Late Tuesday, he wondered whether his resignation would make a difference, because no high-ranking official who praised his service mentioned his stated reasons.

Moorlach noted McAleer’s exit at Tuesday’s supervisors meeting without mentioning McAleer’s concerns. “One would think that would cause some kind of activity, but I wonder what it’s caused,” McAleer said.

At Tuesday’s CalOptima meeting, Refowitz called McAleer “an example of an incredible volunteer,” adding that he wanted “to recognize his incredible contribution to this organization.”

“Everybody says what a great guy, sorry he’s gone, and nobody stops to say why he’s leaving,” McAleer said. “And if you look at my letter, it has nothing to do with my personal life,” he said.

McAleer said he has watched silently since Nguyen was appointed and has seen the agency dissolve into chaos because of her micromanagement and jockeying for control of the agency.

More than half the agency’s top executives have left in recent months, jeopardizing CalOptima’s transition in the next few years to operations under the new national health care law.

“How can you run a $1.4-billion organization with more than half the attrition of your senior managers? Why are they able to leave so quickly? Because they were quality executives … ,” McAleer said

“We’re dismantling all the things that made us a statewide and nationwide model. Who could sit and watch that?”

McAleer acknowledged that Nguyen has arrived as an agent of change but he questions what kind of change she is bringing.

“Supervisor Nguyen came on the board and believed there were significant issues with CalOptima. I have yet to see those significant issues come to light, and I reached the point where I can’t support the changes anymore,” he said.

“I hope officials will look at what CalOptima was a year ago and what it is now,” he said.

Nguyen, who has portrayed the senior executive ranks of CalOptima as out of touch with their responsibilities as a semipublic agency, has repeatedly said she is attempting to make the agency more transparent by asking tough questions.

McAleer said he has learned that many of the top executives who left the agency were called to Nguyen’s office and grilled on their performance. That created a chill over the executive ranks, he said.

There are two ongoing investigations of board members, and on Tuesday, Kacic was asked to step down while an inquiry about his own dealings at the agency concluded.

Kacic on Tuesday characterized the review of a private-public partnership he lead at the agency as puzzling, saying the partnership was handled properly.

“Tens of millions will be coming into Orange County,” Kacic said, adding that there has been “no tangible benefit that has accrued to anyone.”

Nguyen shot back at Kacic, saying, “I’ve never disputed MSC [Managed System of Care] as a good entity or that the mission was incorrect,” she said. “The one thing that I’ve asked — and I haven’t seen it to this day — is a business plan.”

Nguyen also criticized plans to purchase a new building for a CalOptima program for elderly care called PACE (Program of All-Inclusive Care for the Elderly).

Because much of the battle and debate over these issues has taken place in closed sessions, Nguyen said she can not discuss them publicly. In fact, on Tuesday, board members danced around a series of issues saying they involved closed session deliberations.

On Tuesday, Nugyen told Kacic he had instigated his own public ouster by refusing to step aside quietly while the reviews finished.

“We thought it would be simple, it wouldn’t embarrass anyone,” she said.

McAleer said the jockeying for control has destroyed the agency.

“We’ve become the group trying to get Ed Kacic as opposed to the group that’s here to serve the most vulnerable,” McAleer said. “I can’t do it anymore.”

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