Updated PHHS investigation documents provide details on mismanagement of client cases, department finances, and personnel issues

New information has been released about the investigations into former Public Health and Human Services Director Alison McIntyre and former Behavioral Health Services and Clinical Manager John Spieker. The investigations were the result of complaints filed with Cook County Human Resources in April.

WTIP previously reported on the investigation findings first publicly discussed by county leadership in September. At that time the public information was limited, due to data protection laws that limited significantly what could be considered public record. Administrator Kristen Trebil-Halbersma presented the general information to the PHHS board at that time, but could only share limited detail.

On Oct. 3 the county was able to share the findings in a less-redacted form. The findings comprise of two documents, one compiled on May 6, 2025, and one compiled on July 25, 2025. The investigations remained open into the fall, and McIntyre and Spieker officially resigned in August. McIntyre and Spieker are named in both updated documents. The names and identifying information for any remaining staffers who participated in the investigations have remained redacted, as are some of the supporting documents deemed protected by state law.

Trebil-Halbersma said that the county requested that the investigators amend the original level of redaction, which only identified McIntyre, in order to share more information. The investigators determined that, as a supervisor, Spieker, like McIntyre, was not protected by some of the state data use statutes that keeps personnel information out of public records.

This allowed the inclusion of Spieker’s name and identifying information, creating a clearer picture of the findings of the investigation. Trebil-Halbersma said, “To be as transparent as possible, we did want to make sure that we were providing as much information as we legally can.”

The investigation findings showed three primary concerns in regard to McIntyre and Spieker’s time with the county. The documents identified problems with client case management, financial management, and personnel management.

Client case management

While any details about individual PHHS clients remains redacted, the findings documents outline several instances where client cases were mishandled. The mismanagement included issues such as failing to follow protocols for out-of-home placement, failing to notify relevant service teams about case decisions, and staffers being assigned to cases without appropriate training. The documents reference one occasion during which a client, after being transferred several times between facilities, was missing for 48 hours.

The July 25 document stated that though Spieker was not exclusively responsible for some of the client case concerns, “Spieker’s handling of the above client matters fell below the standard of proficiency and care expected of him.”

The document included a summary of McIntyres responsibility for client services. It read:

“As the Department Head, McIntyre’s passive supervision of Spieker also played a part in what transpired in the above client matters. She was well aware of Spieker’s lack of experience in the public sector when he was hired. Concerns were brought to her on a consistent basis by PHHS employees, and she did not take an active part in addressing the concerns. As a result, McIntyre’s lack of urgency, oversight, and care contributed to the poor client outcomes.”

In addition to the specific cases that Spieker had a hand in managing, the documents also point to several situations where PHHS staffers he managed were asked to provide services for which they were not trained. According to the July 25 report, some staffers requested additional support and training, and were met with aggression and resistance from Spieker.

Financial Management

When the initial findings were released, Trebil-Halbersma explained some of the financial mismanagement uncovered in the documents. There has been a systematic problem within PHHS about reporting services provided, meaning the county has missed out on revenue in the form of state reimbursement. The findings point to a lack of both training and oversight within Spieker’s team at the time.

The July 25 document stated, “Spieker and McIntyre failed to actively hold staff accountable for their time entry, which has greatly impacted administrative reimbursement revenue. There is little accountability for revenue capture, follow-through on training, and overall critical management of expenses by McIntyre.”

In addition to the lost revenue, the report also cited an instance where a client remained in an in-patient care facility with a rate of $50,000 per month, when the projected in-patient cost was just $4,000. Over the length of the individual’s care, this amounted to $500,000 in costs to the county.

Trebil-Halbersma explained that in some cases, a client may require care though a restrictive placement, sometimes based on state mandate, and that those placements can be quite expensive. She said that this type of cost would not, necessarily, be inappropriate, if the care were deemed necessary. However, the county should continue to evaluate that need, and have a client moved to a less restrictive, and less expensive placement, if possible. The investigation found that Spieker failed to file paperwork to initiate a transfer, and thus this individual remained in the more expensive care.

The financial irregularities have raised questions of budgetary oversight. Auditor-Treasurer Braidy Powers told WTIP that his office does not have statutory authority for county budgeting, and instead works to review department budgets alongside the administrator. He added, “PHHS is the exception to that.  Since the county moved to the administrator form of government in 2013 I stopped attending PHHS monthly board meetings.  Their budgets/finances are complicated by state and federal laws/funding and it takes some familiarity with those to ask the right questions.”

“The administrator has the primary budget responsibility.  The county commissioners have the responsibility to be comfortable before they approve budgets,” Powers said.

When it comes to the irregularities of the recent past, there have been instances where county commissioners raised questions about the PHHS budget. Powers cited a specific instance in 2023, the first year mentioned in the findings with unexpectedly high expenses and low revenue, when former Commissioner Stacey Johnson questioned the large expenditures that exceeded the budget during a PHHS board meeting. According to Powers, “More information was promised at subsequent meetings but I don’t see that it was provided.”

Back in September Trebil-Halbersma and Interim PHHS Director Plamen Dimitrov both spoke at that month’s PHHS board meeting about the plan to provide better oversight moving forward for staff who provide services with reportable hours for reimbursement. This could include providing additional training to staff, and closer monitoring from leadership.

Trebil-Halbersma said that she hopes to build a “culture of curiosity” at the county, encouraging county staff and elected officials to ask more questions if they notice outlier data, and that regular reviews of budgets are thorough. She added that while the county Commissioners and other PHHS board members are encouraged to ask questions, the ultimate responsibility of department heads and the administrator, with the guidance of the auditor-treasurer to ensure that department budgets have been adequately reviewed.

WTIP requested comment from former Administrator James Joerke on the subject of the financial inconsistencies, and whether in his review of the PHHS budget during his tenure those discrepancies were looked into. At the time of publication WTIP had not had a response from Joerke.

Personnel management

Both findings documents also shared details on the workplace culture at PHHS. The investigations found that despite many PHHS staffers approaching her with their concerns about Spieker’s mismanagement of client cases and department finances, in addition to his treatment of subordinates on his team, McIntyre failed to take corrective actions.

The May 6 document included allegations that Spieker yelled at PHHS staff and clients, and that his treatment of staff led to the breakdown of his relationship with his team. That document also stated that PHHS previously employed an outside consultant to help Spieker with conflict resolution, “but the process appears to have been abandoned amid staff turnover and transition.”

The environment within the department was described as “toxic,” and the documents included reports from staffers that Spieker’s behavior was the cause of the high rate of turnover in the behavioral health team.

In the July 25 document, McInytre is reported to have acknowledged that she had received many reports from different PHHS staffers regarding Spieker. The document reads:

“Despite these repeated and consistent reports, McIntyre passed Spieker out of probationary status, failed to advance any defined action plan for improvement, did not issue discipline, and did not formally arrange for any additional training or mentoring for Spieker. McIntyre’s lack of leadership and passive approach to supervising Spieker has caused direct harm to PHHS.”

WTIP also requested comment from Joerke about whether he was aware of the concerns raised by employees during his time as administrator, because personnel management falls under the purview of county administrators. He did not respond to this request by the time of publication.

Moving forward

McIntyre and Spieker have both left their positions with the county. The department has struggled with short staffing since the summer. In September the behavior health team, which includes 19 positions total had eight vacancies.

Trebil-Halbersma said the county is working to fill the vacancies across the department in a timely manner, and has hired candidates that she said have appropriate skills and experience. She added, “We’re also working on the onboarding process for the new staff so that they do have the skills and abilities to do the work and feel supported in that.”

In an effort to support both current and new staff, the county has partnered with other counties. The aim of that partnership is to provide additional support on procedure, allowing Cook County staff to consult on practices with their counterparts in other counties.

The county has filled six of the vacancies within the department, but despite holding two rounds of finalist interviews for the Director position, they have yet to hire a new leader for the department. Trebil-Halbersma said that after the two interview rounds, conducted each by a different panel comprised of members of the PHHS advisory boards, county commissioners, and representation from Grand Portage, the county opted not to hire any of the candidates. She said the job would be reposted soon, and that at this time Dimitrov will remain interim director.

WTIP’s Kirsten Wisniewski spoke with Administrator Kristen Trebil-Halbersma about the new information related to investigations into PHHS. Audio of that interview is below.

Kirsten Wisniewski October 16, 2025