A drug addict prepares a needle to inject himself with heroin in front of a church in the Skid Row area of Los Angeles. I(AP Photo/Jae C. Hong)
In the halls of power, the perception is we’re a bunch of cork-sniffing whiners.
NIMBYs. Squealers. Crybabies. The body brokering, drug abuse, human trafficking, insurance fraud, occasional death and general chaos attendant to poorly run addiction treatment homes we say are rampant in Southern California? It just isn’t real!
Despite the federal prosecutions. Despite the emergency calls and spasms of chaos. Despite the lawsuits. Despite the body counts.
Officials here on the Rehab Riviera have been working — for years — to convince officials there in Sacramento that, truly, California’s addiction treatment industry is plagued by scammers while state oversight is nearly non-existent, and those who allow it to continue have blood on their hands. Yes, lawmakers have passed new laws — which no one really enforces — but they’ve rejected myriad bills that could have professionalized the treatment system and set more watchful eyes on scofflaws.
“Maddening” does not begin to capture the level of frustration. But there glitters, in the near distance, a slim ray hope, one that SoCal officials await with the anticipation kids might reserve for Christmas morning: A report by the California State Auditor!
Seriously. More than a year ago, Assemblymember Diane Dixon, R-Newport Beach, asked for an official examination of the California Department of Health Care Services, the agency that licenses and regulates addiction treatment homes. Just about anyone can open one, just about anywhere, and if something goes awry it can take months between a complaint and a visit from an analyst.
“I’ve held meetings in my district with local officials, community leaders and constituents all focused on how to be sure people who need help are getting real treatment and that businesses operating without a license in residential settings are held accountable,” Dixon said by email. “I am looking to this audit to inform me on future legislation and am anxiously awaiting the results.”
Us, too. SoCal officials have poured fervent hopes into this audit. According to its scoping documents, it will “provide independently developed and verified information related to the Department of Health Care Services’ oversight of licensed recovery and treatment facilities,” and will include, but not be limited to examining:
• The laws, rules and regulations relating to addiction treatment in California.
• DHCS’ processes for licensing and certifying alcohol and drug treatment facilities, and how it monitors those facilities (including whether licensing and certification are different for homes serving six or fewer people).
• DHCS’ process for investigating and resolving complaints, and how long that takes.
• DHCS’ process for inspecting licensed facilities, including the frequency of inspections and “whether it does so in person.”
• Whether DHCS evaluates the effectiveness of treatment and patient care at facilities.
That’s not all: The auditor is also scrutinizing DHCS’ license data to figure out if the same business owners, operators or management companies are circumventing laws that dictate six-or-fewer clients per facility (by getting separate licenses for nearby properties that are actually part of the same — bigger — treatment empire), and if DHCS has any way to detect or prevent that sort of thing.
The problem that gets at is “overconcentration” — the morphing of a residential neighborhood into treatment campuses, which folks in Costa Mesa and Newport Beach and Malibu can tell you a lot about. The auditor will be looking at whether DHCS weighs this, and its impact on people’s ability to recover.
And there’s more! The auditor wants to know how often DHCS denies licenses, and why? How often does it suspend or revoke licenses, and why? Does it enforce sanctions against facilities operating without a license? How, and what are the penalties?
People at a hearing concerning California’s addiction treatment system in Costa Mesa in 2019.(Photo by Mark Rightmire, Orange County Register/SCNG)
The audit was supposed to be out months ago, but it was knocked off track and then got back on track. It’s slated to be released this fall, said Dana Simas, spokeswoman for the State Auditor — which, technically, began Sunday, Sept. 22, and ends on Saturday, Dec. 21.
Local cities groaning under the weight of complaints about unruly facilities hope it will provide the hard, cold, evidence to convince the many legislators in Sacramento who currently dismiss criticism as NIMBY-ism. Some are bracing for disappointment, sure the auditor will go easy on DHCS and conclude that tragic outcomes are rare and everyone down here is nutty.
We’re not so sure. We’re pretty big fans of the State Auditor’s Office. It has produced some very hard-hitting (though polite) critiques — and there’s so much to hit hard here. The California Sober Living and Recovery Task Force has encouraged folks to provide testimony for the auditors, and some rather devastating accounts have been forwarded to them, including the tragic tale of Brandon Nelson.
In 2018, Nelson, 26, was diagnosed with bipolar affective disorder. His parents, Rose and Allen Nelson, were sold on Sovereign Health for his treatment with promises of top-tier mental health care — psychiatrists, psychologists, therapists. “Lies,” Rose Nelson says in the video.
He was discharged from a Laguna Beach psychiatric facility on March 7 and went to an unlicensed Sovereign “sober living home mental health facility” in San Clemente. Nelson failed to get his medications on time “so that Sovereign could supply the prescription order from a pharmacy they owned,” suffered another psychic break and was left unattended by Sovereign staffers who had no experience dealing with serious mental illness, the lawsuit they filed against Sovereign says.
Left alone, Nelson hanged himself with a pair of sweatpants from the fire sprinkler in his room on March 8, 2018. That top-tier team included guys with experience in furniture moving and construction and credit card processing and house painting, who took online CPR classes, who were too freaked out by his body dangling from the ceiling to recall the address for the 911 dispatcher.
The Nelsons won an $11 million settlement against Sovereign. But his death wasn’t only Sovereign’s fault — California’s mental health treatment system, and those who stubbornly refuse to raise the quality bar for the vulnerable people in it, failed him as well.
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