Two clients of Sound Community Services last week described cutbacks in services over the last three to four years that they said have affected their care, and sharply criticized management practices and questionable spending by the agency's top administrators that they believe may be linked to the service cuts.

The spending practices, recounted in recent articles in The Day, include more than $200,000 in airplane, hotel, meal and other charges on Sound Community Service credit cards issued to Gail Lawson, agency president and chief executive officer; Chief Informatics Officer Christopher "Heath" Bish; and Chief Financial Officer Cindy Kirchhoff. The State Auditors of Public Accounts are reviewing the charge card records and other financial information. In addition, the state Department of Mental Health and Addiction Services has been closely monitoring the nonprofit agency since December.

"How can they justify taking from sick and suffering people?" asked a client who asked to be identified only as Jane S. "I live on a budget, and at the end of the month, I'm going to food pantries, and other clients are going to food pantries. I don't see how these people can go to five-star hotels and gourmet dinners when clients are going to soup kitchens."

A client support fund that used to pay for bus tickets to doctors' appointments, dishes, used furniture and other household items for clients setting up apartments no longer exists, the clients said. While the amounts to pay for these items were relatively small, they said, this support meant a great deal to clients' well-being, they said.

"Now there's a sign on the door that they won't take more clients, yet they have a $10 million budget," said client Ray Freemer, referring to a sign posted at the State Street offices in New London for the past several weeks. "It just makes me lose faith. I would like to see some accountability higher up."

Neither Lawson nor Jane Cable, chairwoman of the agency's Board of Directors, responded to requests for comment. State and federal funds are the main source of the $10 million budget that supports the agency.

Both clients volunteered for interviews with The Day. They were accompanied during the interview by an individual familiar with- but not employed by - the agency and its clients, to ensure the two were comfortable and not feeling pressured.

"I would like to see a deeper commitment to care," said Freemer, a client of the agency since 2006. "They definitely need more prescribers, so we can be seen and monitored more closely. The one I saw last had 190 clients."

Now, he said, he has appointments about once every two months with the doctors who prescribe and monitor the psychiatric medications that help him maintain stability. At one time, it was once every three weeks, a schedule he preferred. It took weeks before he could get an emergency appointment for a bout of severe vomiting that occurred due to a medication reaction, he said.

Three of his friends who are also clients were recently forced to seek care at the Lawrence + Memorial Hospital emergency department because they were unable to get an appointment with a prescriber at Sound. All three were having bad reactions to psychiatric medications, ranging from severe insomnia to extreme fatigue, and became combative in the hospital, he said.

Freemer said he tried unsuccessfully to switch to another agency that provides outpatient mental health care. With more than 700 clients, Sound Community Services is the region's largest provider of outpatient mental health services for adults.

"Even though it's hard to adjust to someone new at Sound, it's even harder to get in somewhere else," he said.

Both he and Jane S. praised the direct care staff they have dealt with over their combined 20 years with the agency, describing them as committed, compassionate and highly skilled. But their effectiveness, the two said, has been undermined by high caseloads, high turnover of counselors, prescribers and other staff, and lack of funds for support programs for clients, a trend they began noticing three to four years ago. In November 400 clients received letters from the agency telling them the agency did not have sufficient prescribers to prescribe and monitor their medications and advising them to seek care elsewhere.

"I got that letter, and I did need some medications," Jane S. said. "I went to my Community Health Center doctor and she didn't know what to do, because she doesn't see me in that capacity."

The woman said she now has an appointment in April with a Sound Community Services prescriber who will be leaving the agency shortly after that.

"Three to four years ago, I would have told anyone - 'Go to Sound. They're there to help you,'" the woman said. "But since then, it's a different story."

The high staff turnover, which a group of former employees blamed on tyrannical management practices in a letter to the board this summer, has been very difficult for clients, the two said.

"They weren't deadbeats who were leaving. They were good people," Jane S. said.

Freemer said it takes him at least six months to develop a trusting relationship with a counselor. In his six years at the agency, he has had seven different counselors, he said. At one time patients would learn of a pending departure in advance and have transition appointments, but now, he said, the agency just sends out letters notifying them to make an appointment with a new counselor.

One of the most recent staff departures was of Toni Vasquez, an employment specialist at Sound for two years. Earlier this month, she announced she was taking a similar job with another agency. Her department received a $212,000 state grant to pay salaries for two full-time and one part-time employee, but for much of her time there, she was its only staff, she said.

In a parting email to her colleagues, Vasquez explained that she decided to end her time with the agency earlier than she had anticipated after she learned about the spending practices of the three top administrators. She said she felt disgusted and resentful, and staff are afraid they will be punished if they speak out.

"For the almost two years I have been with (Sound Community Services) I have given my all and have seen many of you do the same, from completing notes in a timely manner, running from appointments to meetings and then having to pick up other duties as (the agency) became understaffed and under tremendous scrutiny," she wrote in her email.

Now, Vasquez said, she feels she and other staff have been "played like puppets." She and other staff often felt "badgered" by the administration about maximizing billable time with patients on the electronic medical records system, she said.

"We've been understaffed for prescribers and clinicians alike," she said. "Some of them have astronomical case loads. We all knew upper management was taking business trips, but we were completely naive to the whole situation. It's really upsetting everything that's gone on."

j.benson@theday.com