Just days before a delirious Henry Lehr bolted from a licensed Newport Beach detox, forced his way into a neighbor’s house and was killed, the detox operator was cited for eight deficiencies by state regulators.
Lehr died on Aug. 26, and later Gratitude Lodge was cited for failing to get him to a higher level of care in a timely manner. But today, Gratitude Lodge’s three addiction treatment facilities — two in Newport and one in Long Beach — remain open and licensed by the state.
Gratitude Lodge addressed the issues raised by state inspectors, and the California Department of Health Care Services accepted the operator’s “corrective actions,” officials told Assemblywoman Cottie Petrie-Norris during a hearing about the troubled industry held Monday, Dec. 13.
That answer drew a rebuke.
“Each and every time you appear to not even be giving this facility a slap on the wrist,” Petrie-Norris said. “Nothing is changing. Nothing is improving. We learn at an early age that consequences matter….This industry is learning they can do whatever the hell they want and you’ll write them a fix-it ticket. At some point, the blood of these kids is not just on the hands of these horrible operators, but on your hands as well.”
Passions flared at Monday’s hearing, designed to highlight the issue so DHCS might step up its enforcement of addiction treatment facilities. New director Michelle Baass, who was appointed to the job in September, listened as multiple speakers said the state is tragically failing the very people it is supposed to protect.
After Petrie-Norris read a statement from the mother of Matthew Maniace, a 20-year-old who died at a Lake Arrowhead home that was a licensed detox — after being falsely assured of around-the-clock medical supervision — Petrie-Norris asked Baass what she would say to Maniace’s mother.
There was a pause. “Any death is a tragic loss of life,” Baass finally said. “We take these incidents very seriously. I am sorry. I feel sad for the mother.”
Petrie-Norris pressed on. “Do you think California is doing a good job managing and regulating these substance use treatment facilities?”
“Clearly,” Baass said, “every regulatory agency can do a better job at oversight.”
Petrie-Norris continued, expanding her frustration to include the lack of regulation as well as lax oversight: “It’s pretty shocking to most Californians when they learn you need a license to fish or cut someone’s hair, but right now anyone, anyone can open a drug treatment facility and operate without any certification or license.”
Quality standards, please
Dr. Mario San Bartolome Jr. of the California Society of Addiction Medicine, outlined California’s Jekyll-and-Hyde approach to addiction treatment.
On one side are the Medi-Cal-funded programs, which must adhere to scientific, evidence-based care to get reimbursement from the public insurance program. Those are both licensed by the state, and certified for quality. On the other side are private pay-as-you-go and health insurance-funded programs, which have to be licensed by the state, but aren’t legally required to follow any specific quality standards.
Someone in crisis coming into the Medi-Cal system would be seen by a physician who will check the patient’s medical history and weigh things like previous seizures and other issues before deciding the type of care needed. That care might be as intensive as a hospital stay, or as relaxed as outpatient care, but it would be overseen by medical professionals.
But a patient in crisis coming entering the private system might get that sort of screening — or, more likely, little to none at all.
“It doesn’t make sense to me it would be a different standard, only because of the payer,” Bartolome said. “We’re still taking care of the same people. It should not just be an option to provide care that’s evidence-based. If you’re a parent or a loved one looking for programs, there’s no standardization to know exactly what’s going on….It should be simpler to understand what you’re getting.”
Addiction has been marginalized and walled off from the mainstream health care system, and people in crisis are paying the price for that, said Jennifer Lohse, vice president and general counsel of the Hazelden Betty Ford Foundation.
“More needs to be done,” she said. “In order to ensure ethical, quality care, we support efforts to have mandatory, consistent, enforceable standards for addiction treatment. We strongly support mandatory certification…I remain shocked at the lack of comprehensive approaches in the entire continuum of care.”
Stronger enforcement, please
When she was a council member and mayor of Costa Mesa, Orange County Supervisor Katrina Foley helped shepherd hotly-contested city ordinances governing sober living homes.
“We don’t want to be us verses them,” Foley said at the hearing. “All of us have family members who struggle with addiction. We want access to safe and medically appropriate treatment. That’s the key.”
While sober homes are distinct from licensed treatment centers — sober homes are supposed to be people in recovery living together like a family, with no formal treatment happening, thus requiring no state licensing — they are often closely tied to licensed treatment centers. And many have sparked strife in neighborhoods all over Southern California.
Foley asked Baass if the state would consider distance requirements between facilities to prevent the over concentration, or “institutionalization,” of neighborhoods. Baass said they could discuss that further. Foley also pushed on the adequacy of the state’s enforcement arm, with all its inspectors in Sacramento and the majority of treatment programs here in Southern California. The issues at Gratitude Lodge underscore the problems, she said.
“It’s critical to be able to supervise patients in detox properly,” Foley said. “The failure of this facility to comply with even the most basic requirements raises questions about meaningful oversight by the state.”
Foley then suggested that a paradigm shift is needed to better protect health and safety of people in the rehab system — an idea that several public commenters agreed with.
“Every 11 minutes somebody is dying of another overdose,” said Wendy McEntyre, whose son died in a sober living home, quoting national statistics.
“Sixteen U.S. citizens will have died by the end of this hearing. This current model of treatment is not working. No more for-profit treatment. No more treatment in residential neighborhoods.”
Baass and other department officials said changes are coming.
In coming year, the agency plans to start publishing an easy-to-read online dashboard with metrics consumers can use to choose substance use treatment programs. And discussions to require all programs to be certified for quality are under way.
“Mandatory certification holds much promise for quality and safety,” Baass said.