They were as young as 14, 16, 18. Seeking celebration, relief, escape. Many were inexperienced users who thought they were taking OxyContin, or ecstasy, or cocaine, but were fooled by an even more lethal drug — fentanyl.

It cost them their lives.

Fentanyl is a cheap, synthetic opioid — 50 to 100 times stronger than morphine — that’s pouring into California over the Mexican border, masquerading as other drugs and leaving carnage in its wake.

With overdose deaths related to fentanyl surging, state Sen. Pat Bates, R-Laguna Niguel re-introduced a bill on Dec. 15 that would task California’s Attorney General with getting a firmer handle on the problem and crafting coherent solutions.

Modeled after an earlier legislative effort targeting methamphetamine, Senate Bill 75 would require the A.G.’s office to establish and chair a “Southern California Fentanyl Task Force” to enhance law enforcement agency coordination, recommend changes to the law and bring a state-wide caliber of expertise to the issue. It would cover the hard-hit counties of Los Angeles, Orange, Riverside, San Bernardino and San Diego.

“This issue is so widespread that it needs state coordination and implementation over several levels of government to see the effectiveness and results that were attained by other AG task forces,” says a primer on the bill.

It’s a bipartisan effort crafted with Orange County Sheriff Don Barnes and co-authors Assemblymembers Cottie Petrie-Norris, D-Laguna Beach and Marie Waldron, R-Escondido; and Sen. Melissa Melendez, R-Lake Elsinore.

“As a former social worker who once worked in communities ravaged by drugs, (I believe) California must do more to save people from fentanyl-related tragedies,” said Bates in a prepared statement. “A task force would help maximize existing resources and improve communication among various agencies.”

The new bill is the latest incarnation of an idea Bates introduced in March, which was sidelined as the Legislature pivoted to the pandemic. Lawmakers hope to accomplish a major overhaul of the troubled addiction treatment industry next year.

Body count

The pandemic has only pumped up overdose deaths. Consider:

-The U.S. Centers for Disease Control tracked 32,000 deaths from synthetic opioids last year — primarily fentanyl. It’s projecting deaths will leap more than 26% this year, to some 46,000.

-In California, the toll has been grim. There were 104 fentanyl-related overdose deaths in 2014; quadruple that in 2017 (431); and almost quadruple that in 2019 (1,513).  Officials expect fentanyl-related deaths to spike to some 1,900 in the Golden State in 2020.

In Los Angeles County alone, deaths soared from 117 in 2017 to a projected 783 in 2020, Bates said. And it’s not because there’s an exponentially-growing number of hard-core drug addicts; it’s because fentanyl has made its way into recreational drugs bought by occasional, casual users, many parents say.

“We commend legislation and coordinated efforts to protect people from fentanyl-related deaths and the crisis that is plaguing our communities not only in California, but nationwide,” said Bill Bodner, the Drug Enforcement Administration’s special agent in charge in Los Angeles. “Fentanyl is the number one drug killer among 25 to 34-year-olds in the greater LA area. We’ve seen a tremendous increase in the number of counterfeit pharmaceutical pills coming into the U.S. These pills are disguised to look like Oxycodone, but they are actually fentanyl. DEA Los Angeles seized over 700,000 fentanyl pills in the greater LA area this past year and that’s almost double what was seized the previous year. Because it only takes a small amount to be lethal, 700,000 pills on the streets of our communities could have had tragic consequences.”

In 2013, only 3% of overdose deaths in Los Angeles County involved fentanyl. But by last year fentanyl was linked to 32.8% of the county’s overdose deaths, and in the first seven months of 2020 it was nearly 50%, said Nicole Nishida, spokesperson for the U.S. Drug Enforcement Administration.

“Fentanyl continues to pose a substantial risk to our communities,” said Orange County Sheriff Barnes in a prepared statement.

“As a state we must enhance our efforts to reduce the prevalence of this opioid from our communities. The current trend of rising fentanyl-related deaths is unacceptable.”

The victims are not only the users: Cartels increasingly lure young people, often students, to smuggle drugs across the border with promises of money and electronics, officials said. First responders are at risk as well: After police pulled a car over on Dec. 15, in Orange, a man tore open a plastic bag and dumped fentanyl on the ground, spilling it on the shoes and pants of officers and suspects. A small amount of the drug can be lethal.

The Senate has not yet set a hearing date for the bill. Bates has also authored several bills seeking to add fentanyl to the lost of dangerous drugs that are subject to penalty enhancements. Those haven’t been successful, but she plans to keep trying.

Amy Neville’s son Alexander died at age 14 after ingesting fentanyl. She appreciates the effort behind the bill, but wants more.

“If California’s fentanyl crisis was a patient in the ER, I do not think that the doctors would meet in the conference room for four years so they could analyze and determine how to help the patient,” she said by email. “We have hundreds of front line workers already familiar with the problem: coroners, EMTs, firefighters, police, sheriffs, DEA/ICE partners, and civilians. It would not seem hasty to pool these resources and have proposals within six months instead of four years.

“People are dying and lives are being ruined by this scourge and it should be addressed with a similar urgency we have seen in the COVID-19 pandemic. The CDC and local health departments have been extremely responsive to the pandemic, there is no reason that we cannot be just as responsive towards this.”

Updated 12/21/2020 with comment from Amy Neville, and 12/22/2020 with comment from DEA

The fast-cut trailer to the new movie “Body Brokers” is a dizzying and seductive collage of guns, cash, addiction and prostitutes, punctuated by a nicely dressed man holding a finger to his pursed lips as he says: “Shhhh.”

“Body Brokers” then drops the curtain on what it says is an open secret in the nation’s rehab industry, where drug addicts are reduced to commodities that can be recruited and recycled for big profits, and then kicked to the curb when their insurance runs out. It is a scenario also explored by the Southern California News Group’s 2017 project, “Rehab Riviera.”

Related: Actress Melissa Leo talks ‘Body Brokers’

The movie is not a documentary but it is labeled as being based on actual events.

However, this month, the rehab industry issued a strongly worded letter to the film’s producer and the media, demanding the film carry a different label: “fiction.”

Though they’ve only seen the trailer, the letter, signed by behavioral health and addiction rehab experts from throughout California, say the movie is sensational, irresponsible and likely to scare off addicts who need the services offered by legitimate treatment centers.

The tug-of-war over the independent, low-budget film comes as a handful of California lawmakers step up their war against rogue substance abuse clinics. Two Orange County legislators this year proposed or renewed bills that would force licensed treatment centers to carry insurance coverage and outlaw false advertising — regulations that would be new in the largely unregulated industry.

In her legislative pitch to raise standards in the rehab industry by requiring operators to carry insurance coverage, Assemblywoman Cottie Petrie-Norris, D-Laguna Beach, decried that “fraudsters and scammers” were amok in California’s addiction industry.

And that is the world of director John Swab’s “Body Brokers.”

Swab says he was a street junky for more than a decade, bouncing from detox to detox all over the nation. He says he was brokered — meaning he and his insurance were sold by a third party to a rehab operator — and that he then learned to broker other addicts as part of a multi-billion dollar insurance scam.

Yet, according to the letter from behavioral health experts, Swab’s depiction of that world is wildly exaggerated.

Officials overseeing public addiction treatment programs – which operate in a separate universe from private programs – blasted the filmmaker for “a highly inaccurate” depiction of substance use disorder treatment as driven by greed rather than care.”

Veronica Kelley, director of the San Bernardino County Department of Behavioral Health and president of the County Behavioral Health Directors Association of California, which represents every county in the state, was among those who signed the letter. She said the film doesn’t spell out what she views as stark differences between higher-quality publicly-run programs and commercial, privately-run programs, where anything often goes.

“In the public system, because we’re dealing with taxpayer money, there’s a higher level of accountability,” Kelley said. Public programs, she noted, must not only be licensed by the state and certified by professional organizations, but they’re audited annually by state and federal officials.

She knows both sides. A close relative, she said, sought addiction treatment through the private, commercial system and got caught up in a brokering scenario similar to the transactions depicted in the film.

“What we’re saying in our letter is, this is just one side. People don’t know the difference between the commercial and the public systems. This represents a part of the system that needs to be revamped, absolutely,” Kelley said. “We would love for the commercial side to look more like ours. But the film is generalizing to say that all substance use disorder treatment is predatory.”

Those who want help through the public system can call 800-968-2636, she said.

Kelley’s description, however, is more tempered than the group’s letter, which said the  “irresponsible” focus of the movie could very well cost lives.

Swab said those critics had no right to attack his version of his own life.

“We’re flattered people are talking about it,” Swab said. “But this is my truth. I went through this.”

Producer Jeremy Rosen said it would be worse to look the other way.

“It is wildly reckless to ignore this is happening,” Rosen said, although he conceded, “It’s a film, not a documentary. There is some poetic license.”

There have, in fact, been numerous legislative changes to addiction treatment in California in the wake of Southern California News Group’s “Rehab Riviera,” but they were hardly sweeping. Lawmakers acknowledge that the changes they’ve made, so far, have only nibbled at a much greater problem.

Assemblywoman Petrie-Norris says licensed treatment centers and those funded by the government should carry insurance coverage in case patients become prey. But most legislators are reticent to jump into the frey. 

“California regulates anything that moves,” Petrie-Norris said. “But for some reason … it’s been open season for scammers and fraudsters.”

Petrie-Norris has joined forces with state Insurance Commissioner Ricardo Lara to push AB 1158, which would require licensed treatment centers and other clinics that receive government funding to maintain a minimum amount of insurance coverage. Standards of treatment and consumer protections would then be set to qualify for that insurance.

What Lara brings is a statewide enforcement staff of 300 people, enough manpower to enforce basic health rules in the industry — something that currently isn’t part of the state regulatory system.

“There is (now) a total lack of regulation and oversight in this space and people are dying as a result,” Petrie-Norris said.

Another strike at “bad actors” in the rehab world comes from Sen. Pat Bates, R-Laguna Niguel, who reintroduced Senate Bill 434, which would essentially forbid treatment programs from lying.

Hailed by activists as a long-overdue, common-sense measure, Bates’ bill would prohibit false advertising and marketing about such basics as where a center is located – “at the beach” can mean 15 miles away –  and as vital as what services are offered.

Bate’s bill is called Brandon’s Law, after Brandon Nelson. Nelson’s parents were told he was going to a state-of-the-art mental health care program where he’d be closely monitored by a licensed therapist and a psychiatrist. In reality, Nelson wound up in an unlicensed, unregulated “sober living home mental health facility” in San Clemente, where he had a psychotic break and hung himself in  2018.

This is Bates’ third attempt to get the bill enacted. Still, Brandon’s father, Allen, of Santa Monica, remains hopeful.

“It’s obviously disappointing that it wasn’t signed the first time, but we’re certainly in for the long haul,” he said.

The proposal would authorize the California Department of Health Care Services to investigate allegations of misconduct at rehab centers and impose sanctions when warranted.

“If this is passed and enforced, it will bring meaningful change for the consumer,” said David Skonezny, founder of “It’s Time for Ethics in Addiction Treatment,” a private Facebook group of more than 5,600 treatment professionals seeking to raise the bar.

“This is one of the areas where the profession has done a great disservice to the public by misrepresenting itself in ways great and small.”

Skonezny, a substance abuse counselor, has been in the business for years. He said he was prepared to hate the “Body Brokers” movie, but he didn’t.

“The movie is a really accurate look at what happens in the for-profit, privately-funded programs that are lacking in integrity,” he said. “This janky guy running this call center, picking up addicts off the street; a girl turning tricks in a motel to pay for dope for her and her boyfriend, people getting paid off all around – yep. That’s what it looks like.”

Bates agrees. She has been working on the issue for years, and is hopeful the film might finally bring the reality home to her fellow lawmakers, who have been sluggish to act. She’s hoping to organize a screening in Sacramento just for legislators.

“The man who wrote the story lived it,” she said. “It’s hardly fiction.”

The Instagram accounts belonged to “fentanyl_top” and “mass_chemical_drugs” — the 21st century cyber street corners teens visit when looking for an escape, a high, a party.

Amy Neville found those via her smart, curious, 14-year-old son Alex’s account after his death. He bought what he thought was oxycontin from an online dealer and died in his Aliso Viejo bedroom after ingesting what turned out to be fentanyl — a cheap synthetic opioid up to 100 times more powerful than morphine.

The grief-stricken Neville reported the accounts to Instagram — and was stunned when they weren’t immediately removed. They “likely” didn’t go against Instagram’s community guidelines, automated responses said.

It has been nearly a year since Alex died, Today, those particular accounts have vanished. But dozens more like them have popped up on Instagram, on Snapchat and on other social media sites, with names riffing on fentanyl, oxycontin and all manner of illegal drugs — just a click or two away.

“These social media sites are the kids’ playground. We have to make the playground safe,” said Neville. “In the ideal world, the platforms would find these accounts and shut them down. If it’s illegal offline, it needs to be illegal online. Seems like a no-brainer to me, but when there’s billions and billions of dollars at stake, I guess things are different.

“We need to do something,” she said. “People are dying every single day.”

Nationwide protests

On Friday, June 4, protesters demanding that social media giants do more to curb deadly drug sales on their platforms will gather at the Santa Monica headquarters of Snapchat, at the Chinese Pavilion in downtown Riverside and at more than 30 cities across the nation, from Oregon to Ohio and New York to Florida.

It’s the work of volunteers and more than 40 parent-driven nonprofits like the Alexander Neville Foundation and the Association of People Against Lethal Drugs, many of whom are working to stiffen criminal penalties for peddling fentanyl. These are poisoning deaths, not drug overdoses, they say, and need to be treated that way.

“My sister was 20 years old. She died Nov. 7, 2020, after taking a quarter of what she thought was a Xanax, but turned out to be pure fentanyl,” said Victoria Antunez of Riverside.

“People are getting away with selling these deadly pills, and getting away with it because there is no law in California yet. We have to shift people’s ways of thinking and the stigma on death and drugs. It is fentanyl poisoning, not overdose, because each one of the people that we are representing during this rally was blindsided into thinking they were taking something which would’ve been harmless, but because of the fentanyl, they ended up dying.”

Antunez’s sister, Athena Zepeda, was herself an Instagram influencer and an MMA fighter. “Never spoke a bad word about anybody, was always the life of the party and the go-to person for anything,” Antunez said. “We miss her so much.”

Before Athena’s death, the family knew nothing about fentanyl, Antunez said. Now, they’ve connected with more than 100 families in the Riverside area whose lives have been affected by it.

“It is truly an epidemic!” she said.

In February, relationship therapist and TV host Laura Berman’s 16-year-old son Samuel died in his room after taking what was supposed to be Xanax or Percocet, bought from someone he connected with on Snapchat. “My beautiful boy is gone,” she tweeted. “My heart is completely shattered and I am not sure how to keep breathing.”

Taking steps

The list of arrests tied to drug sales on social media is long, including “dealers” busted in Arizona, Pennsylvania, Texas, Tennessee, Indiana  and here in California. Dealers connecting with teens on social media has been documented in countries around the globe.

Media giants say they’ve stepped up their games — and will be doing more.

“For us, nothing is more important than the safety of Snapchatters and we strictly prohibit using Snapchat for drug transactions,” said a company spokesperson by email.

“Drug-related content and activity is firmly against our community guidelines, we aggressively enforce against these violations, and support law enforcement investigations. We try to be as proactive as possible in detecting, preventing and acting on this type of abuse, and are constantly improving our own technology and tools to fight drug dealers and illegal drugs.

“We are also working with parents and safety experts on efforts to raise awareness with Snapchatters about the dangers of fentanyl and other illegal drugs.”

The company said it’s working with experts to further improve its work, including getting regular updates on new terminology, symbols and emojis used to represent and promote drugs; using machine learning tools to improve its ability to find and stop drug transactions; and partnering with dozens of non-profits and “safety partners” in its “Trusted Flagger Program,” which provides them a secure way to report content that violates guidelines and expedites critical safety issues.

Snapchat recently rolled out a new feature, “Friend Check Up,” reminding Snapchatters to review their friend list to make sure they actually know their contacts, and the company also works with law enforcement to support investigations and can preserve relevant content, the spokesperson said.

Facebook, which owns Instagram, echoed Snapchat.

“We do not allow the sale of illicit drugs on Instagram. It is against our policies to buy, sell or trade non-medical or pharmaceutical drugs on our platform,” a spokesperson said by email.

“We have been focusing on this area for some time, and we are working hard to ensure we keep illicit drug sales off Instagram, while surfacing the communities of support that help those struggling with addiction. We know we have more to do in this area, but we will continue to work with experts and invest in people and technology to keep our community safe.”

Instagram will continue investing in technology to keep illicit drug sales off the platform and connect people with help and resources, the company said. That includes “proactive detection” — tools that can spot images of drugs and signals of intent to sell, such as the posting of phone numbers, prices and user names for other social media accounts.

It also launched a “Get Help Feature,” directing people attempting to purchase illegal substances to the SAMHSA national helpline. But addiction is an issue that affects families throughout the nation and world; no company or government organization can address it alone; and bad actors continually update their tactics and terminology to avoid detection, the company said.

Not enough

Some 90,000 people died of drug overdoses in the 12 months that ended in October, according to data from the U.S. Centers for Disease Control — a spike of 30% in a single year, and the highest tally ever.

Officials say that’s because cheap fentanyl is being dressed up to look like real pharmaceuticals — and is killing people.

Berman has been using her platform to push for a law creating “drug-induced homicide,” which was tabled this year, and to push social media companies to allow parents to track their children’s accounts.

“Currently, #TikTok and #Snapchat do not allow parents to protect their kids on their apps, because they prevent parents from using third-party software to monitor when their child is exposed to dangerous content,” Berman tweeted on June 1.

“These apps are essential to help protect our children…. We have a real opportunity to make the world a safer place for this next generation.”

Parents and kids need to understand that fentanyl is out there, in everything, and that a single pill can kill, said Neville, Alex’s mom.

“This is shaping up to be our deadliest summer,” she said. “I know we’re not going to shut down Snapchat on June 4. But it’s important that Snapchat hear from those of us who have wanted to get loud for a while.”

The Dept. of Justice is filing criminal charges against ten people who run drug and alcohol addiction businesses in Orange County, saying the county has overtaken South Florida as the national epicenter for addiction industry fraud.

“The problem was heavily concentrated, historically, in Miami and South Florida. But with active prosecutions (in Florida) the problems have migrated to Orange County,” Assistant U.S. Attorney Benjamin Barron, chief of the Santa Ana Branch Office, said Thursday, Dec. 16.

The Justice Dept. effort, focused on O.C. and dubbed “The Sober Home Initiative,” is expected to reach others in an industry that, in the county, includes hundreds of licensed rehabs and sober living homes.

“This is the beginning, not the end,” Barron said.

Despite new state laws and local efforts to stamp out abuse in the rehab industry over the last four years, the playbook remains largely the same: Private, for-profit addiction treatment centers hire “body brokers” to find vulnerable addicts with good insurance, then pay those body brokers handsomely so that the rehab can bill the insurance company, often for services that don’t meet a patient’s medical needs or are non-existent.

In addition, addicted people are often paid to remain in treatment, and some rehab centers provide drugs to addicts as a way to re-start the lucrative treatment cycle again and again, officials said.

Arrested Thursday, Dec. 16, were Nick Roshdieh, 51, of Aliso Viejo, and Vincent Bindi, 66, of Laguna Nigel. They owned Crest Recovery LLC, doing business as Truvida Recovery, and were charged in an indictment that alleges conspiracy to pay and receive kickbacks for referrals to clinical treatment facilities and paying kickbacks for referrals to clinical treatment facilities.

Donald Vawter, 30, of Rancho Santa Margarita, an employee of Truvida, also was taken into custody, as was Michael Hislop, 56, of Boston, a patient recruiter, on charges of conspiring to pay and receive kickbacks for referrals.

If convicted, Roshdieh and Bindi would face a maximum total penalty of 65 years in prison, and Vawter and Hislop would face a maximum total penalty of 35 years in prison, prosecutors said.

Attorneys for the accused could not be reached late Thursday.

The sting has been underway for at least 10 months.

In October, the Justice Department indicted Casey Mahoney, 45, of Los Angeles, and Joseph Parkinson, 32, formerly of Costa Mesa, charging both for their roles in an alleged multimillion-dollar addiction treatment kickback scheme.

According to court documents, Mahoney controlled Healing Path Detox LLC in Huntington Beach and Get Real Recovery Inc. in San Juan Capistrano, and allegedly paid some $2.7 million in kickbacks to Parkinson and other patient recruiters in exchange for patient referrals. Mahoney is also facing charges of money laundering charges for allegedly transferring kickback funds to an account held in the name of a patient broker’s mother.

Parkinson, a patient recruiter, also was charged with currency structuring and possession with intent to distribute fentanyl.

If convicted, Mahoney would face a maximum total penalty of 35 years in prison, and Parkinson would face a maximum total penalty of 165 years in prison.

Darius Moore, 28, formerly of Santa Ana, pleaded guilty Dec. 10 to one count of conspiracy to pay and receive kickbacks for referrals and one count of receiving kickbacks. His sentencing is scheduled for May 13, and he faces a maximum of 15 years in prison.

Adrian Gonzalez, 37, of Laguna Hills, pleaded guilty on Aug. 6 to paying kickbacks for referrals. He’s scheduled for sentencing on Jan. 28, and faces a maximum of 10 years in prison. He controlled Stone Ridge Recovery Inc. and Landmark Recovery LLC, and paid at least $1 million in kickbacks to patient recruiters for patient referrals.

Dorian Ballough, 30, formerly of Costa Mesa, pleaded guilty on Nov. 12 to one count of conspiracy to pay and receive kickbacks for referrals and one count of receiving kickbacks for referrals. He’s scheduled to be sentenced on April 8 and faces a maximum 15 years in prison. As a patient recruiter for multiple facilities, he was paid at least $1.8 million, according to court documents.

Kyle Reed, 29, formerly of Huntington Beach, pleaded guilty on Nov. 19 to one count of conspiracy to pay and receive kickbacks for referrals and one count of receiving kickbacks for referrals. He’s scheduled to be sentenced on May 6 and faces a maximum 15 years in prison. He was paid at least $604,474 as a patient recruiter for multiple facilities, according to court documents.

The initiative was made possible by the federal Eliminating Kickbacks in Recovery Act of 2018, a new law that Barron called a powerful new tool to help in prosecutions. It passed in the wake of the Southern California News Group’s probe of fraud, abuse and death in the industry.

“The suspects in this case specifically targeted vulnerable individuals in recovery and sold them as a commodity with no concern for their health or wellbeing,” said California Insurance Commissioner Ricardo Lara in a prepared statement. “Receiving kickbacks for patient referrals endangers lives and has no place in our health care system.”

It was a vicious back-and-forth over who was truly evil — the big bad insurance company, refusing to pay for desperately needed addiction treatment for vulnerable patients? Or the greedy, manipulative treatment provider, milking those vulnerable patients for every last cent it could wring out of their insurers, then kicking them to the curb when benefits ran out?

In the battle between now-defunct Sovereign Health/Dual Diagnosis of San Clemente and insurance giant Health Net, the insurer won. Big.

After a trial that lasted some seven weeks, the jury took about a day to decide that Sovereign/DD and its erstwhile CEO Tonmoy Sharma acted with “malice, oppression or fraud,” and that Health Net proved Sharma violated the Racketeering Influence and Corrupt Organization Act.

Sovereign and Sharma must pay Health Net just shy of $45 million in damages and interest, said the jury in Los Angeles Superior Court, where the case was tried.

Health Net, apparently not eager to gloat, said it wasn’t going to comment on the verdict.

One of Sovereign’s attorneys, Lisa S. Kantor, said this: “We believe that there were multiple reversible errors and that the most significant evidence was kept from the jury. We look forward to obtaining a reversal on appeal.”

That $45 million hit to Sovereign and Sharma breaks down like this: Health Net’s damages for fraud and/or intentional interference amounted to $15.82 million, with a $13.31 million cherry on top awarded for interest. Health Net is due another $15.82 million for the RICO violations, the jury said.

It happens that $15.82 million is how much Sovereign billed for urine and other lab tests that weren’t necessary or even ordered by doctors, according to testimony at trial.

Sovereign, which filed the initial lawsuit against Health Net, got zip.

“Sovereign is not an innocent little lamb,” Health Net attorney Kenneth Julian said during closing arguments. “Sovereign is a ravenous wolf, and it took advantage.”

The fight

Sovereign, once a prominent addiction treatment and behavioral health provider in Southern California and several other states, sued Health Net in 2016 after the insurer refused to pay for treatment already provided to Health Net customers.

Sovereign alleged the insurer “engaged in a disgraceful scheme to enrich themselves by backtracking on their insurance promises to recovering addicts and the mentally ill,” and that its “misconduct is part of a sad pattern of prioritizing dollars over decency.”

Health Net owed Sovereign $55 million for services rendered back then — and, with statutory interest, that ballooned to $80 million and beyond, according to Sovereign’s court filings.

Health Net, of course, has a vastly different perspective.

In a counter-suit, it argued that Sharma and his companies engaged in massive fraud that harmed all consumers. In 2013 — before coverage for addiction treatment was mandated under Obamacare — Health Net paid $251,000 to out-of-network providers like Sovereign. In 2015, it paid them more than $190 million, “an almost 1,000-fold increase in just two years,” it said.

Monthly billings from Sovereign’s companies to Health Net climbed from less than $50,000 to more than $13 million within the span of a single year, Health Net said.

Treatment providers gamed and abused the Affordable Care Act, Health Net said. Sovereign and other clinics “engaged in a sophisticated fraud involving paying kickbacks to ‘buy’ hundreds of patients from teams of brokers, or ‘cappers,’ who find the patients in 12-step programs, AA meetings, homeless shelters and jails, often from outside California, and then ‘sell’ them for cash to the highest-bidding clinic,” its suit said.

“Because the prospective patients typically would not be able to afford private health insurance or the cost-sharing obligations associated with receiving services from an out-of-network provider — and who should therefore be enrolled in state-funded or subsidized health care programs such as Medicaid — the providers, including (Sovereign), offer the patients financial kickbacks and inducements.”

The primary inducement is the offer of free care, Health Net said. Sovereign, and providers like it, signed people up for top-tier insurance policies. Those providers — not the clients — paid the insurance premiums. Then the providers either waived — or paid — the patients’ out-of-pocket deductibles and co-pays, which Health Net said violated the policy terms.

Sovereign and the others recouped their cash outlays by billing massive amounts — often for services that were never rendered, were not medically necessary or were not covered, the counter-suit said.

“This scheme, which involves fraudulently obtaining insurance policies and the submission of thousands of false and fraudulent claims, also raises the costs of healthcare coverage to consumers, who ultimately will have to pay higher insurance premiums.” the insurer argued.

‘Patients as pawns’

Sovereign’s lawyers argued that Health Net was ill-prepared for the mass of claims it would get for addiction treatment and simply decided not to pay them.

The legal process dragged on for years and the insurer had years to investigate, gained access to hundreds of pages of documents, “but at the end, their accusations are based on hearsay, innuendo, gossip,” Sander Dawson said. “They call any obvious mistake part of a fraudulent scheme.”

In the end, Sovereign sought reimbursement for just $10 million of unpaid claims and interest on those claims; it couldn’t collect on the rest because it paid for patients, which is illegal, Health Net told jurors.

Health Net was apparently more convincing to the jury.

“Insurance doesn’t work if a person buys insurance when the fire is coming down the hill, puts in a massive claim for their house that has burned down and then cancels it afterwards,” Health Net attorney Gregory Pimstone said during closing arguments.

“It doesn’t work. The system would collapse … and here we have something even worse than that. It’s not just that they bought the insurance as the fire was coming down the hill and then terminated the insurance after the claim had been put in. But here it’s like the contractor is buying insurance for all the homeowners and saying….’Free insurance for you if you let me rebuild your house so I can submit claims to your insurer for rebuilding your house.’

“Sovereign (gamed) the system. It  defrauded Health Net, and it used its patients as pawns.”

We’ll tell you more about the eye-popping evidence in coming days — which includes a “mop-up” team in India padding medical histories, but sometimes forgetting to change patient names — but the legal proceedings aren’t quite over. There will be a short second phase of the trial in September to consider punitive damages.

Sharma was hoping to use the proceeds from this trial to pay hundreds of Sovereign workers who never got paid as the company was imploding in 2018. Those wage claims are still outstanding.

Sharma, however, has been working with a company, Invictus Health LLC. He has said he advises Invictus and other providers about what they need to do and how they need to do it, but said he had no financial stake in the businesses and they cannot be sued in lieu of Sovereign.

Update 8/2/22 to attribute “ravenous wolf” quote to Kenneth Julian

Read trial transcripts:

2022-07-21 Trial Transcript_Redacted

2022-07-19 Trial Transcript (Closing Arguments)

The surgeon who was accused of building a luxurious life on the backs of often-desperate drug users eager to make a buck — even if it meant enduring unnecessary surgeries, getting unnecessary lab tests and receiving unnecessary injections for inflated prices — pleaded guilty to several charges in two separate cases on Friday, Aug.12, according to court records.

Randy Rosen ran Wellness Wave, a surgical center in Beverly Hills, and girlfriend Liza Vismanos owned Lotus Laboratories, a toxicology lab in Los Alamitos. Over the course of just a few years, they billed health insurance companies some $676 million for medical procedures and tests and collected millions in reimbursements, according to court documents that paint a picture of unrepentant greed and callous disregard for human suffering.

Before landing in the Orange County Jail, they were remodeling a $3.2 million mansion — with “jetliner” views of the Pacific Ocean, Santa Monica mountains and downtown Los Angeles; complete with lap pool and wine cellar — high in the hills of Brentwood. They had high-priced cars, expensive purses and jewelry, eclectic art and bars of silver and gold, prosecutors said in court documents.

Rosen pleaded guilty to several counts of submitting fraudulent insurance claims with an aggravated white collar crime enhancement, while scores of other charges were dismissed. He faces 10 years behind bars, but will get credit for the two years he has already served as the cases progressed through the justice system.

Vismanos pleaded guilty on Friday to insurance fraud and had dozens of charges dismissed. She will face home confinement.

“This is the largest prison sentence for a provider in a California workers’ compensation insurance fraud,” said Orange County District Attorney Todd Spitzer in a prepared statement. “Dr. Rosen used vulnerable sober living patients who were desperately trying to battle their demons as an ATM machine to make a buck. He didn’t care about his patients; he only cared about making as much money as possible.”

Rosen’s time behind bars was itself a source of controversy.

Rosen got COVID-19 in late 2020, and a judge released him to his multi-million dollar home to recuperate, for fear of underlying medical conditions.

Rather than enduring lock-up in Orange County’s main jail, Rosen paid $100 a night to stay at the kinder, gentler Huntington Beach City Jail in 2021, raising questions about justice for the rich, and for everybody else.

Attorneys for Rosen and Vismanos said they’d have no further comment.

“I refuse to allow these body brokers to traffic human beings as part of a thinly disguised plot to strike it rich,” D.A. Spitzer said. “People battling addiction and the people who love them are looking for a lifeline to help save them. Dr. Rosen not only grabbed the lifeline out of their hands, he billed the insurance companies to do it.”

This article has been updated with response from attorneys and sentencing detail

“Medically supervised!” boast so many addiction treatment centers — even though they’re explicitly “non-medical.”

Matthew Maniace died in a Lake Arrowhead detox that said it was “clinically supervised” and offered “around-the-clock medical supervision.” So did Terri Darling and James Dugas. In a paranoid delirium, Henry Richard Lehr bolted from a Newport Beach detox that provided “incidental medical services” and broke into a nearby home, where he was shot and killed by the terrified resident inside.

It’s easy to mistake mental health and addiction treatment centers for actual medical facilities in California. But they are not staffed 24/7 by doctors (and are not allowed to be). They’re typically situated in tract houses in residential neighborhoods, and the most stringent medical requirement may be the full-time presence of someone who knows CPR.

Enter Senate Bill 1665 by Sen. Pat Bates, R-Laguna Niguel — an attempt to untangle the pretzel logic of non-medical facilities crowing about their medical services, or exaggerating staffers’ credentials, or promising prescription-drug-level services when no one on staff is licensed to prescribe drugs. It was signed into law by Gov. Gavin Newsom on on Monday, Aug. 22.

No bull

It refines Brandon’s Law, the Bates bill signed by Newsom last year, which prohibits addiction treatment and mental health providers from misrepresenting or making blatantly false claims about the services they offer or where they’re located. That was a long-fought victory for Bates and Nelson’s family, and its meaning seemed crystal clear.

But some operators have tried to skirt it using sophistry, Bates said.

Thus the new law, which expressly forbids drug or alcohol programs from making false or misleading statements about medical treatments or services offered.

“We’re thrilled we got that signed by the governor,” Bates said. But perhaps not so thrilled that every burp and gurgle of what seems obvious and ethical must be explicitly spelled out.

Bates’ intent has always been clear and simple: She doesn’t want people in crisis over addiction and mental health issues to be bamboozled. She doesn’t want them to be misled about what kind of help they’ll be getting. She doesn’t want operators to exaggerate or lie to snag a client. It can be a matter of life and death.

Phantom care

Brandon Nelson had suffered a debilitating psychotic break and was promised the finest care at now-defunct Sovereign Health: He’d be closely monitored by a licensed therapist, and a psychiatrist, and would get group and other forms of therapy, his parents were told.

But Nelson wound up in an unlicensed “sober living home mental health facility” run by Sovereign, didn’t get the hospital-prescribed drugs he needed on time, was left unattended and used his sweatpants to hang himself from the sprinkler system. He was 26 when he died in 2018.

This reporter, who has spent the past five years chronicling the tragic flaws in California’s private-pay, insurance-money-fueled, addiction treatment system, naively thought that Brandon’s Law would stop non-medical facilities from claiming to provide medical supervision. But alas.

There are hundreds of officially non-medical addiction treatment and mental health facilities licensed to provide “incidental medical services” by the California Department of Health Care Services. They are not allowed to provide primary medical care, but can obtain medical histories, monitor patients’ health to determine if emergency care is needed, oversee patients’ self-administered medications.

These IMS facilities typically have a contractual relationship with a doctor, who will look over patient paperwork within 72 hours of admission.

Of course, the first days of detox are the most dangerous. Lehr and Maniace and Darling were dead before 72 hours had passed.

Still, DHCS said that these non-medical facilities did not run afoul of Brandon’s Law by claiming they offer medical supervision.

No hyperbole

The new law will provide penalties — such as loss of license — to dissuade operators from hyperbole, like claiming the staff marriage and family therapist is a certified addiction counselor and the like.

Enforcement action, as always, must begin with a complaint to DHCS (details on how to file complaints here).

The interpretation and enforcement will, of course, fall to the DHCS folks themselves. We asked if the new law will stop rehabs with IMS designations (and without!) from claiming they’re medically supervised.

State officials couldn’t tell us yay or nay by deadline. But Bates said that that’s clearly her intent. If more legislation is required, she’ll do what she can to make that happen — even as term limits mean her time in the state Senate will come to a close this year.

“Families should be assured their loved ones are properly cared for as they begin their journey to recovery,” Bates said in a statement. “Now that SB 1165 is law, I am hopeful more people will feel confident enough to enter treatment and overcome their addiction.”

I will be dropping my daughter off for her freshman year of college in less than two weeks. I am a quivering, gelatinous mass of maternal angst. But I, along with the rest of California, got an assist this week from our lawmakers that will help ease (some of) my fears — and may help keep kids like my daughter alive.

On Monday, Aug. 29, Gov. Gavin Newsom signed into law a bill by Assemblymember Laurie Davies, R-Laguna Niguel, legalizing the possession of those funky kits that test pills et al. for the presence of deadly fentanyl, as well as strips that screen drinks for “date rape” drugs like ketamine and gamma-hydroxybutyric acid.

Until now, they fell under the definition of “illegal drug paraphernalia” and were officially verboten in the Golden State.

The new law, Assembly Bill 1598, “is an innovative step in California’s ongoing battle to rid our neighborhoods of dangerous drugs and actually get addicted users the help they need,” Davies said by email Tuesday during the final, frenetic days of the Legislative session.

“Legalizing testing equipment for drugs like fentanyl or ketamine … can empower parents, school officials and law enforcement to have these products readily available to ensure if there are drugs found, we can prevent accidental overdoses and deaths,” she said.

“This measure is a common-sense approach to improve harm-reduction strategies and certify drugs on our streets are not unknowingly laced with more dangerous chemicals.”

Harm reduction

This logical, welcome-to-the-real-world approach acknowledges that some level of drug use is inevitable.

And rather than trying to achieve total abstinence — impossible, as a little experiment called Prohibition clearly illustrated — it seeks to reduce bad outcomes, say our friends at the National Institutes on Drug Abuse, part of the National Institutes of Health.

“Persuasive evidence” from around the world has shown that harm reduction greatly reduces the morbidity and mortality associated with risky health behaviors, NIH said.

Products like test strips clearly save lives, Davies has said. In 2019, research institute RTI International found that 43% of drug users reconsidered after test strips found fentanyl in pills or powder masquerading as something else.

“We must increase the tools in our tool belt to prevent accidental overdoses and deaths,” she said in analyses of the bill. “One way to do this is to reform our ‘drug paraphernalia’ laws to not criminalize life-saving products and technologies.”

The Orange County Board of Supervisors endorsed Davies’ bill after holding its own hearing on the fentanyl crisis, and supporters included the California Consortium of Addiction Programs and Professionals, California Attorneys for Criminal Justice, addiction medicine specialists and more than a dozen police and sheriff’s groups.

But alas, this session’s major harm reduction bill — allowing safe injection pilot sites in Los Angeles, Oakland and San Francisco — was vetoed by Newsom (even though, as a candidate in 2018, he said he was “very, very open” to the idea). He worried that they might “induce a world of unintended consequences” — including, some have suggested, providing ammunition to opponents if he pursues higher office.

There’s always next year. There’s an argument to be made that civilized societies don’t let their most vulnerable members do dangerous narcotics on sidewalks and then let them die on the streets.

Equipped

Meantime, our what-to-bring-to-college list just got longer.

The law is so new that we’re not going to be able to amble into the local drug store (or head shop) and buy test kits immediately, but we expect that’s not terribly far off.

In the meantime, since these kits are legal in many other states, they can be purchased online. I bought 10 fentanyl test strips and 10 date rape drink test strips which should arrive in time to be tucked into the luggage before drop-off day — which will provide me with yet another opportunity to lecture her about how a single pill can pack enough fentanyl to kill, and how she should never drink from a glass that she hasn’t poured herself or one that she left unattended for even a minute.

She’s a good kid. She’s never gotten into real trouble. Her nose curled in disgust every time I tried to order her a glass of champagne on a recent vacation to Paris (where the legal drinking age is 18). It’s not a terrible world. There are so many good people in it. But there are also some wicked ones, and I want her to have every possible tool at her disposal to keep the bad at bay.

Mother = control freak. I realize she may never, ever use these tools — like she’ll probably never, ever use the nifty screaming alarm with special flash feature I bought for her key chain — but she’ll have them. And I think that makes both of us feel better.

When you lose a child, the what-ifs can be paralyzing. Juli Shamash is part of an unfortunately robust army that’s channeling that agony into change, to spare others from ever having to endure it.

Her son, Tyler, was 19 when he overdosed at a sober-living facility in Beverlywood in 2018. It turns out that the drugs Tyler took contained deadly fentanyl — a single sugar packet of the stuff is enough to kill 500 people — but he was never screened for fentanyl at the emergency room.

“Had it been common practice to do a separate tox screen for fentanyl back in October of 2018, Tyler may still be alive today,” Shamash said by email.

Enter Tyler’s Law, authored by Sen. Melissa Melendez, R-Lake Elsinore, and signed by Gov. Gavin Newsom on Aug. 22. It simply requires a general acute care hospital to include fentanyl testing in its urine drug screenings, and takes effect Jan 1.

“We are confident that this bill will save lives and spare others from the heartache of losing a loved one,” Shamash said.

Folks are surprised to learn that routine drug screens don’t always capture fentanyl use, and many of those who take it never meant to — instead thinking they bought legit prescription pills such as Xanax or Oxycodone. Fentanyl is in just about every street drug as well, from methamphetamine to cocaine.

Shamash, of Los Angeles, is working with an emergency physician from San Diego to make routine ER screening for fentanyl standard in every state. It can convince people to carry naloxone, alert friends who may be using, ditch suspect pills (which can now be legally tested for fentanyl in California) and motivate them to seek help. It can also help law enforcement prosecute drug dealers and help outpatient clinics with data, Shamash said.

Tyler was a brilliant kid who could fix anything, but he struggled with anxiety and couldn’t see his own worth. He wanted so very much to fit in. His family spent hundreds of thousands of dollars sending him to wilderness programs and boarding schools, private treatment programs and sober living homes.

He got the money to buy the drugs that killed him from a “friend” who brokered him to a program in Laguna Hills that accepted Tyler’s insurance — and received $2,000 for his troubles, Shamash said. Tyler got a cut of the take.

Shamash — and a coalition of more than 50 groups including the California Hospital Association, California Medical Association, county health directors, public safety officials and family-based organizations — wants to forge a new path forward on addiction treatment and behavioral health issues. Clearly, with more than 100,000 drug-related deaths in a single year, it’s desperately needed.

The governor’s new CARE courts, which would compel people with serious mental health issues into care and housing, may be part of that change. Be Well Orange County is one of the programs that’s getting it right, according to the coalition, Behavioral Health Action.

One of the important takeaways: “If you’re in the public behavioral health system because you don’t have insurance, or you’re in Medicaid, you have a better chance of getting recovery-based treatment than you do in a private program,” said Steve Fields, the Progress Foundation’s executive director, when the coalition’s new Blueprint for Behavioral Health was unveiled last year.

Shamash wishes she had known that when her son was struggling. But a story told, she has said, is a life saved.

Hey, Gov. Newsom! Hope you’re doing well up there.

For us? Down here, you know, not so much.

I can’t believe it but it has been six years since the Southern California News Group began chronicling the tragic cycle of fraud, death, abuse and abject failure in California’s startlingly unregulated addiction treatment industry. In that time, not much has changed.

You have kids, Gov. Newsom. Can you imagine taking a lost, troubled child to a fancy seaside treatment center — licensed by our state — promising medical supervision and group therapy and a new lease on life, only to learn that the kid died in his sleep because there’s no doctor for miles and no one was checking as he detoxed?

Or because he got hold of drugs packed with fentanyl and overdosed in his room?

Or because he was tossed out for being high and staggered alone to a nearby parking lot and swallowed the rest of the pills in his pocket, dying behind a gas station garbage bin?

I’m a parent, too, Gov. Newsom. If I speak to one more mother or father shattered by this tragedy, whose heart is crushed and pureed with guilt and regret and what-ifs and if-onlys, I may tear all my hair out. You need to hear these parents. You need to do something. Not to expand the system, as some of your proposals to address addiction and homelessness might, but to completely and totally change how the corrupted, private-pay, insurance money-fueled segment of the addiction treatment system works in California.

In case you missed it, the U.S. Department of Justice recently proclaimed Orange County the nation’s epicenter for addiction treatment fraud. Bully for us.

We were so optimistic after publishing “Rehab Riviera” back in 2017. There were hearings in Congress and the state Legislature. There were investigations and arrests and imprisonments and vows to remake the system to better protect vulnerable people exploited to make a buck.

Myriad new laws were passed in Sacramento; some were signed by then-Gov. Brown and some were signed by you.

But, as it turns out, they just nibble around the edges. They simply don’t address the structural issues of a colossal problem that, frankly, is killing people. It also syphons billions of dollars from our health care system.

“Nothing is changing. Nothing is improving,” fumed Assemblymember Cottie Petrie-Norris at a hearing with California’s addiction treatment regulators a little more than a year ago.

“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.”

It’s on your hands, too, Gov. Newsom. You take on Big Oil, climate change, the housing shortage. Yet one bill that arguably could have brought tremendous change to the addiction industry — requiring outpatient centers, where the majority of treatment happens, to be state–licensed and meet minimum standards — you vetoed.

“I am supportive of the Legislature’s intent to license all SUD (substance use disorder) recovery and treatment services,” you wrote. “However, developing a new licensing schema is a significant undertaking…. It is clear that a substantial amount of work is still needed to develop a program that my administration can implement.”

That was more than three years ago. Where is this work? Where is this new schema? Granted, we had a little global pandemic between then and now; folks were busy. But the fact remains that even though I possess no credentials in health care I can still legally hang a shingle and open my own outpatient addiction treatment center and bill insurers thousands of dollars per person per day — and that should terrify us all.

Folks with long, scary rap sheets can and do open rehabs and work in them, too, because you still don’t require criminal background checks.

And please understand that the detox phase is the most dangerous and medically fraught stage of addiction treatment. That’s when folks are coming down off drugs and/or alcohol and are vulnerable to heart attacks, organ failure, seizures, delirium. Because of the grave danger, other states require detox to happen only under real medical supervision by real medical professionals. Yet here in California, you allow detox to happen in expressly non-medical residential rehabs, many of them six-bed tract houses in the middle of suburban neighborhoods, where the most one can hope for is a vocational nurse trained in CPR.

People are dying, Gov. Newsom. Death complaints in state-licensed addiction treatment centers have tripled over the last decade. Tripled. And that doesn’t count the folks dying in unlicensed programs that are completely unsupervised by the state. Like mine would be, if I ran an outpatient center.

So, over the coming months, we at SCNG will be telling you about folks like Frankie Taylor, found dead in his closet at a licensed Anaheim treatment center from an overdose, and how no one has felt compelled to track down how he got the deadly drugs or those who sold it to him. Except his parents.

We’ll be telling you about the New Jersey parents who come to Los Angeles every few months to try to convince their daughter, brokered from rehab to rehab and now living on the streets smoking fentanyl in plain sight, to please, please, please come home.

We’ll be telling you about how new laws aiming to address the mess are actually playing out — some largely ignored because there’s no real enforcement anyway.

Not all of these folks are kids of course, though many of them are, for reasons we’ll explain. We aim to present the problems in bite-sized bits that will reveal tragic patterns and spur you to action. There has never been a better time: California is set to get more than $2 billion in opioid settlement money that’s supposed to spent fighting addiction. And you, Gov. Newsom, are trying to reform our system and readying an initiative for the 2024 ballot “to build state of the art mental health treatment campuses to house Californians with mental illness and substance use disorders.” That would invest billions more public dollars into this sphere.

Please, let’s spend it on programs that work. It could be my kid someday, Gov. Newsom. It could be yours.

The Arlington Recovery Community and Sobering Center is now fully back in business.

The residential treatment wing of the Riverside County-owned facility reopened Monday, April 3, almost four months after state officials shut it down in the wake of a patient’s death last summer.

The sobering center wing, which offers short-term detox, never closed. But county officials fired MFI Recovery Inc., the Riverside company hired to manage the facility, and replaced it with the Bloomington-based Cedar House Life Change Center.

“Together, we aim to provide a safe and supportive environment to help individuals overcome addiction and achieve long-term recovery,” Robert Youssef, a spokesperson for the county’s behavioral health department, said via email.

Cedar House CEO Jamie Lamb said her nonprofit organization is eager to run the facility.

“We have much to offer and we know we’re saving lives,” Lamb said. “This is just one more opportunity for us to do that and we’re very excited about it.”

MFI did not respond to a phone call seeking comment.

The facility on Riverside’s County Farm Road — 54 residential treatment beds and 15 sobering center beds — opened in 2021 at a cost of $28 million. It offers an alternative to jail or the emergency room for people encountered by first responders who show signs of mental illness and addiction.

Melissa Bauman, 24, who had a history of using methamphetamine, heroin and fentanyl, died in the residential treatment wing in July 2022 — two days after checking into the facility following a relapse.

Bauman’s mother, Karri Ryder, is suing the county and MFI for $10 million, alleging MFI’s staff failed to perform required bed checks on her daughter, who died of a fentanyl overdose. Police investigated, but no one was criminally charged in Bauman’s death.

A California Department of Health Care Services inspection after Bauman died found “deficiencies,” Youssef said in December. The state shut down the residential treatment wing Dec. 8 and the county fired MFI the same day.

State records show MFI’s license to run the facility was revoked Feb. 28. According to state records, state officials made an unannounced visit to the facility in 2022 following an “unusual incident/death report” and found 25 violations, including falsified records, a failure to do face-to-face detox checks and determined that MFI “acted beyond the conditions of its license.”

Lamb said Cedar House had to complete a 300-page licensing application and undergo a state inspection, among other steps, before it could take over the facility.

“We’ve put some strong supervisory staff in place that know Cedar House, that know our programs,” she said. “They know the quality and the control that we like to keep.”

Cedar House will do bed checks at “30 minutes or less intervals” and “my staff are well-versed in what we’re prepared to handle and what we’re not and they know to call 911 if it’s necessary,” Lamb said.

“Honestly, these types of things (like patient deaths) happen in these types of facilities and we do everything we can to curtail that and prevent that,” she said. “But just the close watch observation is what enables us to keep that from happening … These clients will not be leaving the facility intermittently. So smuggling something in will not” be an issue.

Third in a regular series. See Dear Gov. Newsom: People are dying in the Rehab Riviera. Do something. and Dear Gov. Newsom: Their daughter’s been swallowed by California’s rehab monster

Hey, Gov. Newsom:

Today’s story is hard to hear, but terribly important. It’s about Frankie Taylor, who was all of 19 when he overdosed at the Lighthouse Treatment Center in Anaheim.

His parents want you to know that Taylor is far more than how he died. The sweet, sensitive type, Taylor loved the stage. He did magic tricks. In fifth grade, delivered a dramatic reading of Rudyard Kipling’s “If,” entirely from memory. Bought an electric guitar 10 days before the school talent show, taught himself to play Johnny Cash/9 Inch Nails’ “Hurt,” and performed it (in black top hat!) to riotous applause.

He was Peter Pan in the community play. Poured himself into original folk-rock songs that detailed a painful, but hopeful, journey. Volunteered with the church youth group. He was an incurable romantic, always had a girlfriend, and consulted his parents on the most thoughtful gifts to bestow upon his paramours.

Taylor, of Oregon, was found unresponsive in his closet shortly after the morning therapy session at a Lighthouse facility on Pearl Street. The official cause of death was “acute polydrug intoxication,” due to the combined toxic effects of fentanyl, narcotic analgesics and anti-depressants, according to the autopsy. That he died of drug poisoning in a state-licensed addiction treatment center — where his dad urged him to go for help — is, to his parents, the cruelest irony.

Seems that since 2014 at least two other deaths have happened at Lighthouse facilities, according to state documents. His parents didn’t know that because California keeps this information buried. There’s no simple, quick way to figure out if a provider has been connected to a death, or deaths, or has been the subject of complaints, or how a provider might have responded to any issues. The records the state released to me (months after they were requested) about deaths at licensed facilities were so heavily redacted it would be laughable if it wasn’t so tragic.

Anyway, Taylor’s dad and stepmom aren’t angry, but they’re plagued by questions.

How, exactly, did deadly drugs make their way into an addiction treatment center? Do dealers loiter nearby, watching for window curtains to part, waiting for a patient’s will to crack? Did someone inside the facility sell to him? Or, perhaps, did he find something in a well-hidden crevice, where a long-gone patient stashed it for a later that never came?

And why won’t anyone – from our state agencies or otherwise, Governor – help them find out?

The Taylors have been trying to get details from Lighthouse since that dreadful day, July 31, 2021.

“We are aware that Lighthouse has done an internal investigation,” his dad, Brad Taylor, wrote to Lighthouse executives nearly a month after his son’s death.

“We feel that we deserve to read the findings. Our hope is that you discovered how the drugs made it into your locked facility and we feel we deserve to know if you have. We also deserve to know how and why our son died. And if you were unable to discover how the drugs made it inside, I would suggest that your current residents are not safe.”

Details were not forthcoming.

The Taylors hoped for a criminal investigation into where the drugs came from. A growing number of prosecutors, including Orange County’s, charge fentanyl dealers with crimes akin to murder. The Anaheim PD was “compassionate,” the Taylors said, but didn’t feel a criminal investigation was warranted.

Grief remains a constant companion.

“For the past two years we have encouraged our son to enter into a locked residential treatment program to fully address his addiction,” Taylor’s dad wrote to Lighthouse officials in 2021. “July 13th he agreed to admit himself to Lighthouse. Just under three weeks later he died. It aches my heart to know that he died following my advice. Please help me understand the circumstances that led to his death.”

He still doesn’t have an answer.

“Mr. Taylor, we received a formal request from your attorney for certain records,” Lighthouse CEO Timothy J. Salyer wrote back after months of these pleas. “Therefore, we have turned the matter over to our attorney. … They have instructed us not to discuss this matter with anyone, including family members. That is why you have not received any response from us. We are truly sorry for your loss…. we would ask that you please refrain from contacting our employees and staff further. How information is provided is out of our hands at this time. We hope you can understand.”

‘Not a healthcare facility’

They don’t.

Frankie Taylor’s parents filed wrongful death lawsuit against Lighthouse and its corporate parents, saying it failed in its duty to properly support and monitor their son to ensure he wouldn’t come into contact with drugs.

“Frankie realized that his disease of active addiction meant that he could not trust himself to make choices about substances,” his dad wrote in testimony for a recent public hearing. “He traded his freedom away and locked himself into a secured residential program so that he did not have to make choices about substances. He bravely exposed his vulnerabilities in daily groups and tore down his walls to try and get to the root of his disease. He was in the safest place he could find.”

Don’t picture some slick medical office; the Pearl Street “facility” where Taylor overdosed is a perfectly ordinary tract house, built in 1979, surrounded by a stubby white fence. His belongings were “thoroughly searched” and all medications were “logged and stored safely by staff” upon his arrival, the suit says. He wasn’t allowed to leave unsupervised. He couldn’t have any visitors. He had to submit to regular drug testing.

But after he left the morning group session on July 31, 2021, and went to his room, “he was somehow presented with an opportunity to make a decision about substances. And being given that choice in your facility led to his death,” Brad Taylor wrote to Lighthouse.

Taylor was taken to the Anaheim Regional Medical Center. An emergency room doctor said Taylor received nine shots of epinephrine, but they were unable to save his life. Taylor, 19, was pronounced dead at 1:40 p.m.

“Frankie Taylor should have had absolutely no access to drugs, prescription or otherwise, without staff administering them to him,” the suit says. Lighthouse “knew or should have known if narcotics were brought into the facility.”

It’s clear what happened, said Darren O. Aitken, attorney for Frankie Taylor’s parents. What the family so dearly wants to understand is how it happened, and stop it from happening again.

Salyer, CEO of the Lighthouse, said he can’t speak about ongoing litigation, and didn’t express great faith that this columnist would accurately relay his message or reflect what he called Lighthouse’s 24 years of service to the community.

But in court filings, Lighthouse said it acted in good faith, did not engage in any willful or intentional misconduct, and did not act negligently at any time. Rather, the company argues, it was Taylor’s fault.

Taylor “failed to exercise the degree of care and caution that a reasonable person would have exercised in similar circumstances,” Lighthouse’s response to the suit says. He “had a duty to use reasonable care to provide for his own well-being.”

Lighthouse is “not a healthcare facility and did not owe a duty to plaintiffs to provide skilled nursing services, acute hospital services, or other medical care,” it said.

Let’s repeat that so we’re clear: California’s addiction treatment facilities, licensed by the state Department of Health Care Services, are not health care facilities and do not owe a duty to provide skilled nursing services, acute hospital services or other medical care.

That’s a vital distinction that largely escapes folks who put faith in websites touting “24/7 treatment staff” and “medical supervision” and the ability to handle “dual diagnosis” on various pages, as Lighthouse’s does.

Not health care facilities. Seems crazy, right? “If addiction is a brain disease,” Dr. Walter Ling, professor of psychiatry and founding director of the Integrated Substance Abuse Programs at UCLA once mused, “where are all the doctors?”

‘Mistakes’

That’s a question California’s regulators should ponder. Hard.

The addiction treatment programs licensed by DHCS are mostly glorified 12-step programs providing group support (and, sometimes, excellent chefs and yoga and horse-petting) and charging health insurers a pretty penny. There’s no hard data anyone can point me to on their long-term effectiveness.

The point we’re trying to make here, Gov. Newsom, is that addiction treatment has been cleaved from the larger medical health care system – even as treatment centers charge rates more frequently associated with medical care, and bill those fees to health insurance companies and desperate out-of-pocket payers. Those billings can run thousands of dollars a day, for a stay in a tract house with no doctor present on staff. Everyone’s the poorer for it.

Why doesn’t California require folks to see a bona fide addiction medicine physician before checking in to a state-licensed rehab?

Why doesn’t it push the gold standard of addiction care — drugs like buprenorphine, which bind to the brain’s opioid receptors to essentially block a high — in the private-pay, insurance-money fueled sector of the treatment universe (where Frankie Taylor landed) as hard as it pushes that gold standard in public programs?

It bends the brain a bit, but, “If you’re in the public behavioral health system because you don’t have insurance, or you’re in Medicaid, you have a better chance of getting recovery-based treatment than you do in a private program,” Steve Fields, the Progress Foundation’s executive director, recently said.

We understand that addiction is often a fatal condition. People die. But there’s clearly a better way.

“I can accept that a mistake was made that resulted in my son coming across fentanyl while living in a secure facility. I do not, however, accept that his life and his death are not worth learning from,” Brad Taylor wrote.

“As a career social worker who has worked with hundreds of individuals who manage the disease of addiction, I do not expect any system or facility or staff member or person to be perfect. But if we want to improve our world and help those with addiction disorders to improve their lives, we need to raise our standards of care, eliminate the barriers of access, address the stigma that is assigned to those with the disease, and provide clarity and transparency when our systems, our facilities, our staff, our loved ones, and ourselves make mistakes.

“I am willing to let my experience as Frankie’s father inform and strengthen our community’s ability to support those who are sick,” Taylor wrote. “I call on treatment programs, and our community leaders, to do the same.”

Listen to Frankie Taylor’s original songs, “All Up From Here” and “A Good Life“

Fourth in a regular series. See Dear Gov. Newsom: People are dying in the Rehab Riviera. Do something, Dear Gov. Newsom: Their daughter’s been swallowed by California’s rehab monster and How did Frankie Taylor overdose in a state-licensed addiction treatment center?

Dear Gov. Newsom: Today we’ll take a break from harrowing tales of tragedy and death in California’s (poorly regulated, private-pay, 12-step based, insurance-money fueled) addiction treatment system to visit with Dr. Walter Ling, a neuropsychiatrist who’s worked in addiction medicine for nearly as long as you’ve been alive.

Please listen to what he has to say. For thousands of people, it’s a matter of life and death.

Ling has the remarkable gift of clarity, frequently quotes his mother’s wisdom, has an infectious optimism — and will be the first to tell you that his formidable foray into addiction treatment was entirely by accident. The plan was simply to finish neurology and psychiatry training at Washington University in St. Louis and return to the Chulalongkorn University Medical School — he was born in China and grew up in Thailand — but then he met May, a local teacher volunteering at a children’s hospital. Wedding bells rang. May felt that pull west, dearly wishing to raise their kids in California, so he took a job at the Sepulveda VA Hospital in Los Angeles in 1971.

We’ll jump ahead a bit to tell you that Ling has had a hand in studying every major medication for opiate addiction in the United States, is founding director of UCLA’s Integrated Substance Abuse Programs and a keen chronicler of how addiction treatment cleaved from mainstream medicine and was schluffed off to its current, expressly non-medical, silo.

Over there, it’s oft overseen by “recovering” addicts who may or may not be recovered.  “Medication-assisted treatment” is still widely shunned. And detoxification — the initial weaning off substances — is tragically mistaken for treatment itself.

“The most common outcome of detoxification,” Ling has written, “is relapse.”

Here are a few of his Mama Ling-esque pearls of wisdom you should memorize:

• Detoxification may be good for a lot of things, but staying off drugs is not one of them.

• The difference between getting off drugs and staying off drugs is the difference between a wedding and a happy marriage. The wedding is a big deal, but it has nothing to do with a happy marriage. Right now, our entire treatment system is targeted to the wedding.

• You can’t get a life if you can’t stay off drugs. And you can’t stay off drugs for long if you can’t get a life. Taking medication is the best guarantee that you don’t die from an overdose and actually stay off drugs.

• The term “medication-assisted treatment” itself is puzzling. What is the medication assisting? It is the treatment.

• If addiction is a brain disease, where are all the doctors?

Gold standard

Shortly after the young Ling family arrived in California, the good doctor was helping out on the general psychiatric ward at the Veteran’s Administration hospital. Nixon was president. Veterans were returning home from Vietnam with troubling heroin addictions. Something had to be done.

Sepulveda had one of the VA’s first methadone programs, and Ling was asked to fill in for a few of weeks when the chief of psychiatry and research was out of town.

The rest, as they say, is history.

Ling worked with these rattled and traumatized young people to find out how best to help them. He helped run myriad scientific studies of medications designed to address addiction, publishing hundreds of papers that have been cited thousands of times.

All three medications approved to treat opioid addiction had to endure Ling’s watchful gaze: methadone, naltrexone, and buprenorphine. These drugs can bind to the brain’s opioid receptors, foil opioid highs, manage cravings, head off overdoses and, generally, pave the way for that happy marriage.

Buprenorphine, in particular, is far more convenient, and thus effective, at keeping people off drugs for the long haul than its medical cousins. And most any medication is more effective than the ubiquitous 12-step approach alone. That, Gov. Newsom, is why medication is an integral part of California’s push for better treatment in its public addiction treatment programs.

But not so much in the private sphere of California’s addiction treatment system.

“Look around the treatment industry and ask whether things have really changed,” Ling writes. “We have studied addiction as a science for more than 40 years, but we treat our patients the way we did 40 years ago.”

In 2023 — after decades of research showing that medication is the gold standard for getting a life — much of California’s treatment system continues to shun it.

• Just 22% of California’s outpatient facilities — where most treatment happens — offered methadone, buprenorphine or naltrexone treatment, according to federal data. 

• Only 59% of programs transitioning people back to their regular lives offered overdose education and Naloxone, a drug that can reverse opioid overdose and practically bring people back from the dead.

• Overall, a tremendous chunk of treatment facilities in California — 41% — didn’t provide any “pharmacotherapy services” for their patients at all, despite skyrocketing overdose and death rates.

“We know that medication plays a critical role in keeping addicts off drugs but we insist on assigning medication a secondary role,” Ling writes. “We call addiction pharmacotherapy ‘medication-assisted treatment’ even though there is nothing that the medications are supposed to assist that works. …

“Even when we reluctantly tolerate the use of medications, we want patients to get off them as soon as possible. Nationwide, detoxification is still the most common, most profitable and least effective treatment offered; it has an over 90% relapse rate. We expect detoxifications to return patients to their old non-addict self, ignoring the fact that once addicted, they can’t turn back the clock of their body and brain to before addiction. We act as though we believe contraceptives don’t just keep you from getting pregnant but make you a virgin again.”

Historically, addiction has been viewed as a criminal offense and a moral failing. Medical intervention took a big back seat to behavioral approaches.

“Counseling by counselors who themselves had a history of addiction was based on the premise that counselors’ shared life experiences could uniquely help patients enter into recovery,” Ling writes. “This hypothesis was never tested or proven true, despite becoming a routine component of treatment. Instead of serving to extend patient care, counseling grew into a parallel service often in conflict with the physician’s treatment goals.”

We require doctors who prescribe medications to connect patients to counselling, but we don’t require abstinence-based treatment facilities to connect patients to medical treatment.

We don’t want to go against the abstinence treatment industry, and we let the regulatory agencies become symbiotic with the system they regulate.

And that, Gov. Newsom, is the crux of it.

“We don’t need more treatment that is not treatment,” Ling has told us. “If we want to find sensible solutions, we should stop doing things that don’t work.”

California has the resources and compassion to make such changes, Ling believes. We’re slated to get more than $2 billion in opioid settlement money for fighting addiction. And you, governor, are trying to reform our system and readying an initiative for the 2024 ballot “to build state-of-the-art mental health treatment campuses to house Californians with mental illness and substance use disorders.”

Please. Build a system that treats addiction, first, as a medical issue. Of course, doctors are not all angels — we’ve chronicled the surgeon accused of building a luxurious life on the backs of often-desperate drug users, and the doctors getting kickbacks for ordering gazillions of unnecessary drug urine tests — but I’d rather put my life, and my kid’s life, in the hands of someone with eight years of schooling and three to seven years of residency, instead of the guy who dropped out of high school but has cycled through seven behavioral treatment programs, relapsed as many times, and has been triumphantly sober for five months.

“Yes, we can do better,” Ling writes. “We need to support the use of prescribed medications like buprenorphine and provide the resources to help patients live a life without drugs. We know what we must do, and we have the tools to do it. It’s been said that we Americans love reality shows because if we put things on TV, we don’t have to face them in real life. But if we want to succeed in fighting opioid addiction and reduce overdose deaths, we must have the courage to look in the mirror, resist our biases, acknowledge where we fall short, and find the gumption to make real changes to finally end this crisis.”

“It took away the pain — all the pain,” said a doctor who fell victim to the charms of Oxycontin. “In the brain, in the heart, in the body. That’s what we’re up against.”

Every day in California, 20 people die of opioid-related overdoses, and many thousands more wrestle with the ravages of addiction. After years of legal wrangling, the companies that made and distributed the first waves of these super-addictive drugs — aggressively pushing doctors to prescribe them and insisting they weren’t addictive — are doing a financial penance that’s washing into most every neighborhood in America.

California and its counties will get about $3.5 billion over the next decade-plus from opioid settlements, according to the Attorney General’s office. The first waves of that money are arriving, and the lion’s share of it is in the control of local governments — primarily your county board of supervisors, but also cities.

To date, California’s state and local governments are owed $425 million from various opioid settlement funds, with $59.5 million for Los Angeles County and its cities, $22.7 million for Orange County and its cities, $17.7 million for Riverside County and its cities, and $12.7 million for San Bernardino County and its cities, according to data from Brown Greer, court-appointed funds administrator, and published by the Kaiser Family Foundation.

Hundreds of millions more will funnel to California governments over the next several years. This money is meant to ameliorate harm. Will it, can it, actually make a difference?

“Policymakers, community leaders, and all those affected, want to avoid the outcomes of the tobacco litigation, in which only 2.6% of litigation payouts actually went to smoking prevention and cessation programs,” said a blueprint for wise settlement spending compiled by experts from Harvard, Johns Hopkins, Yale, Stanford, RAND Corporation and others.

“State and local policymakers will, in many cases, have considerable discretion over how these lawsuit dollars will be spent in their communities — and they will need to weigh important trade-offs and make evidence-informed decisions to ensure the funds are well-spent.”

The money won’t come close to covering the $1 trillion in public and private costs of the opioid crisis, wrote Rebecca Lee Haffajee and Bradley D. Stein of RAND. But the infusion of dollars could quickly save lives and mitigate lifelong harms.

“It matters how this money is earmarked for use,” they wrote. “Settlement money should be spent in three areas that research shows will substantially reduce deaths and improve lives: preventing overdoses and other harms to those using opioids, providing evidence-based addiction treatment, and offering services for mothers and children affected by the crisis.”

Transparency is vital as these funds make their way into the world, said Stein, director of the NIH-funded RAND-USC Schaeffer Opioid Policy Center and senior physician policy researcher at RAND. But getting specifics from local governments is still very much a work in progress.

Destination: Still largely unclear

In giant Los Angeles County, which gets the biggest slice of the pie in Southern California, a county team is working on the final details of a multi-year spending plan that will be presented to the Board of Supervisors “as soon as possible,” officials said.

Officials are working with community-based service providers — who are on the ground and understand the most critical needs — to shape L.A. County’s plan, and the public will get to weigh in soon when it goes to the Board of Supervisors for approval. Expect to see proposals for harm reduction and overdose prevention programs, as well as recovery housing and youth education.

San Bernardino County is working on a plan. So is Riverside County, focusing on training, enhancing data collection, prevention, treatment, recovery efforts and a public education campaign. It’s expected to go to the Board of Supervisors this summer.

Costa Mesa hasn’t decided where to spend the money yet. Neither has the city of San Bernardino.

Santa Ana plans to use the money for homeless-related services, to buy naloxone and train first responders. The Riverside city council will debate the same options in late August, and will also consider using the cash to fund new positions like substance use disorder counselor, social worker and/or behavioral health clinician.

More than a dozen cities’ shares are so small they’re forwarding it to the County of Orange. The County of Orange has launched a data dashboard tracking “Orange County Drug and Alcohol Misuse and Mortality trends” to better target services where they’re needed, to be funded with settlement funds, and plans to provide medication-assisted treatment to folks in jail, greater support for pregnant women and families, buy Narcan and fentanyl test strips and launch a public education campaign.

Newport Beach, though, is forging ahead. It plans to use $396,000 to make naloxone — the drug that can reverse overdoses and essentially bring people back from the dead — more readily available beyond police and firefighters, including training workers at bars, restaurants, hotels, gas stations and other common places people might overdose.

“We will also be developing a public outreach campaign aimed at educating the public on the availability of Narcan, how to use it, and encouraging people to use it when in doubt (no downside if a person isn’t overdosing),” said John Pope, spokesman for Newport Beach, by email.

“Our thought is that most people understand the risks at this point, so we won’t be repeating the ‘one pill can kill’ type messaging. Instead, we want to make Narcan distribution more of a public health resource, similar to having first aid kids handy and knowing the basics of how to use it.”

Newport Beach has an internal working group that will keep tabs on the program and make adjustments. “One thing we’ll learn is how much Narcan to buy, how much gets used, and how we plan for that,” Pope said. “There’s an expiration date attached so we don’t want to buy less than we need, but also don’t want to buy a whole lot more. I could see some of the training components living past the grant, like the school presentations.”

Blueprints for wise spending

The opioid settlement agreements have taken pains to be specific about how the money can be spent, and how it will be reported, in an effort to not repeat past mistakes.

Back in 1998, state governments reached an enormous, 25-year, $246 billion deal with the nation’s largest tobacco companies. It was to be penance for lies about the lethal effects of smoking and fund anti-tobacco programs. But what happened has been the source of debate, discouragement and disappointment, said Harvard University’s Allan M. Brandt in the Harvard Gazette.

“The $246 billion was used to fill budget gaps, build roads, and for other purposes; only very rarely was it used for any form of public health, let alone reducing tobacco use, treating those who were addicted, and protecting kids from becoming smokers,” he said. “It’s become a notorious example of collecting a lot of funds through litigation, but not getting those funds to those who most need or deserve them. I think a lot of people have watched the emergence of the opioid litigation with the tobacco settlement cloud hanging over the proceedings.”

To dispel that cloud, experts have been working for years on blueprints for wise spending.

RAND says that distributing naloxone, detecting fentanyl, providing sterile syringes and connecting people to adequate housing are the quickest routes to immediately and effectively reduce overdose rates.

Experts at Johns Hopkins offer five basic principles:

• Spend money to save lives (not fill budget holes);

• Use evidence to guide spending (fund treatment that offers medication to curb opioid abuse — not simply AA-style 12-step programs so ubiquitous in California);

• Invest in youth prevention (not simply school campaigns warning about drug danger, but real support for families struggling with addiction, as those kids are most at risk);

• Focus on racial equity;

• And develop a fair and transparent process for deciding where to spend the money (“guided by public health leaders with the active engagement of people and families with lived experience, clinicians, as well as other key groups.”)

Taken under advisement

With all that in mind, California’s Department of Health Care Services has issued a 17-page “allowable expenditures” bulletin to guide local governments as they wrestle with spending decisions right now.

Settlement money should be spent on “creating new or expanded substance use disorder treatment infrastructure,” interventions to prevent addiction in vulnerable youth, diverting people from the justice system to effective treatment, buying naloxone and addressing the needs of communities of color. And there’s an emphasis on medication-assisted treatment, still rejected by 41% of California’s licensed and certified treatment centers.

It’s still very early, but RAND’s Stein is cautiously optimistic.

“Overall, my sense is that, with the guardrails the states and others have set up, we’ll be able to avoid some of the worst things we saw in the tobacco settlement,” he said.

“We want to see the money flowing toward what works. Harm reduction. Treatment with medication. We know there’s a solid evidence base there, and that’s good.

“Where you see some concerns is in communities where funds go to treatment facilities that provide no medication treatment at all. While it isn’t going to work for everyone, it should certainly be an option.”

The singular focus on overdose deaths — overlooking those who use and remain very much alive and struggling — dearly needs attention, he said. “We have much poorer data on the range of harms that aren’t fatal overdoses. That heavily impact families and children.”

Transparency and inclusion are concerns of Susan G. Sherman of Johns Hopkins.

“Every context and community is different and is going to have different needs. But one thing that’s vital no matter where you are is: Who do you have in the process? Who is helping draw up these plans? Officials? People actively using? Family members?” she said. “You’re cutting yourself off at the knees when you’re not including a whole range of people. It’s often easier to have family members rather than people who are using, but the services serve them and they know what their needs are. That also provides meaning, and we know that having meaning in their lives allows them to make different choices.”

The public will get input when plans go to boards and city councils for approval, officials said. It’s a rare opportunity.

“For a generation or more, the U.S. has made little investment in building the capacity of the substance use disorder treatment system,” a coalition of experts said. “That system ….has not been subject to the requirements of modern health care, including the critical need to promote evidence-based treatment. As a result, a range of practices have been allowed to co-exist, leaving to chance whether consumers receive treatments that work or treatments that may be ineffective or even harmful.

“Abatement funds from opioid-related litigation offer an opportunity for a significant resetting of how we will deliver care for opioid use disorder in the future. …Thus, promoting ‘what works’ is of critical import.”

Staff writer Laylan Connelly contributed to this report.

“Medically supervised!” boast so many addiction treatment centers — even though they’re explicitly “non-medical.”

Matthew Maniace died in a Lake Arrowhead detox that said it was “clinically supervised” and offered “around-the-clock medical supervision.” So did Terri Darling and James Dugas. In a paranoid delirium, Henry Richard Lehr bolted from a Newport Beach detox that provided “incidental medical services” and broke into a nearby home, where he was shot and killed by the terrified resident inside.

It’s easy to mistake mental health and addiction treatment centers for actual medical facilities in California. But they are not staffed 24/7 by doctors (and are not allowed to be). They’re typically situated in tract houses in residential neighborhoods, and the most stringent medical requirement may be the full-time presence of someone who knows CPR.

Enter Senate Bill 1665 by Sen. Pat Bates, R-Laguna Niguel — an attempt to untangle the pretzel logic of non-medical facilities crowing about their medical services, or exaggerating staffers’ credentials, or promising prescription-drug-level services when no one on staff is licensed to prescribe drugs. It was signed into law by Gov. Gavin Newsom on on Monday, Aug. 22.

No bull

It refines Brandon’s Law, the Bates bill signed by Newsom last year, which prohibits addiction treatment and mental health providers from misrepresenting or making blatantly false claims about the services they offer or where they’re located. That was a long-fought victory for Bates and Nelson’s family, and its meaning seemed crystal clear.

But some operators have tried to skirt it using sophistry, Bates said.

Thus the new law, which expressly forbids drug or alcohol programs from making false or misleading statements about medical treatments or services offered.

“We’re thrilled we got that signed by the governor,” Bates said. But perhaps not so thrilled that every burp and gurgle of what seems obvious and ethical must be explicitly spelled out.

Bates’ intent has always been clear and simple: She doesn’t want people in crisis over addiction and mental health issues to be bamboozled. She doesn’t want them to be misled about what kind of help they’ll be getting. She doesn’t want operators to exaggerate or lie to snag a client. It can be a matter of life and death.

Phantom care

Brandon Nelson had suffered a debilitating psychotic break and was promised the finest care at now-defunct Sovereign Health: He’d be closely monitored by a licensed therapist, and a psychiatrist, and would get group and other forms of therapy, his parents were told.

But Nelson wound up in an unlicensed “sober living home mental health facility” run by Sovereign, didn’t get the hospital-prescribed drugs he needed on time, was left unattended and used his sweatpants to hang himself from the sprinkler system. He was 26 when he died in 2018.

This reporter, who has spent the past five years chronicling the tragic flaws in California’s private-pay, insurance-money-fueled, addiction treatment system, naively thought that Brandon’s Law would stop non-medical facilities from claiming to provide medical supervision. But alas.

There are hundreds of officially non-medical addiction treatment and mental health facilities licensed to provide “incidental medical services” by the California Department of Health Care Services. They are not allowed to provide primary medical care, but can obtain medical histories, monitor patients’ health to determine if emergency care is needed, oversee patients’ self-administered medications.

These IMS facilities typically have a contractual relationship with a doctor, who will look over patient paperwork within 72 hours of admission.

Of course, the first days of detox are the most dangerous. Lehr and Maniace and Darling were dead before 72 hours had passed.

Still, DHCS said that these non-medical facilities did not run afoul of Brandon’s Law by claiming they offer medical supervision.

No hyperbole

The new law will provide penalties — such as loss of license — to dissuade operators from hyperbole, like claiming the staff marriage and family therapist is a certified addiction counselor and the like.

Enforcement action, as always, must begin with a complaint to DHCS (details on how to file complaints here).

The interpretation and enforcement will, of course, fall to the DHCS folks themselves. We asked if the new law will stop rehabs with IMS designations (and without!) from claiming they’re medically supervised.

State officials couldn’t tell us yay or nay by deadline. But Bates said that that’s clearly her intent. If more legislation is required, she’ll do what she can to make that happen — even as term limits mean her time in the state Senate will come to a close this year.

“Families should be assured their loved ones are properly cared for as they begin their journey to recovery,” Bates said in a statement. “Now that SB 1165 is law, I am hopeful more people will feel confident enough to enter treatment and overcome their addiction.”

“Medically supervised!” boast so many addiction treatment centers — even though they’re explicitly “non-medical.”

Matthew Maniace died in a Lake Arrowhead detox that said it was “clinically supervised” and offered “around-the-clock medical supervision.” So did Terri Darling and James Dugas. In a paranoid delirium, Henry Richard Lehr bolted from a Newport Beach detox that provided “incidental medical services” and broke into a nearby home, where he was shot and killed by the terrified resident inside.

It’s easy to mistake mental health and addiction treatment centers for actual medical facilities in California. But they are not staffed 24/7 by doctors (and are not allowed to be). They’re typically situated in tract houses in residential neighborhoods, and the most stringent medical requirement may be the full-time presence of someone who knows CPR.

Enter Senate Bill 1665 by Sen. Pat Bates, R-Laguna Niguel — an attempt to untangle the pretzel logic of non-medical facilities crowing about their medical services, or exaggerating staffers’ credentials, or promising prescription-drug-level services when no one on staff is licensed to prescribe drugs. It was signed into law by Gov. Gavin Newsom on on Monday, Aug. 22.

No bull

It refines Brandon’s Law, the Bates bill signed by Newsom last year, which prohibits addiction treatment and mental health providers from misrepresenting or making blatantly false claims about the services they offer or where they’re located. That was a long-fought victory for Bates and Nelson’s family, and its meaning seemed crystal clear.

But some operators have tried to skirt it using sophistry, Bates said.

Thus the new law, which expressly forbids drug or alcohol programs from making false or misleading statements about medical treatments or services offered.

“We’re thrilled we got that signed by the governor,” Bates said. But perhaps not so thrilled that every burp and gurgle of what seems obvious and ethical must be explicitly spelled out.

Bates’ intent has always been clear and simple: She doesn’t want people in crisis over addiction and mental health issues to be bamboozled. She doesn’t want them to be misled about what kind of help they’ll be getting. She doesn’t want operators to exaggerate or lie to snag a client. It can be a matter of life and death.

Phantom care

Brandon Nelson had suffered a debilitating psychotic break and was promised the finest care at now-defunct Sovereign Health: He’d be closely monitored by a licensed therapist, and a psychiatrist, and would get group and other forms of therapy, his parents were told.

But Nelson wound up in an unlicensed “sober living home mental health facility” run by Sovereign, didn’t get the hospital-prescribed drugs he needed on time, was left unattended and used his sweatpants to hang himself from the sprinkler system. He was 26 when he died in 2018.

This reporter, who has spent the past five years chronicling the tragic flaws in California’s private-pay, insurance-money-fueled, addiction treatment system, naively thought that Brandon’s Law would stop non-medical facilities from claiming to provide medical supervision. But alas.

There are hundreds of officially non-medical addiction treatment and mental health facilities licensed to provide “incidental medical services” by the California Department of Health Care Services. They are not allowed to provide primary medical care, but can obtain medical histories, monitor patients’ health to determine if emergency care is needed, oversee patients’ self-administered medications.

These IMS facilities typically have a contractual relationship with a doctor, who will look over patient paperwork within 72 hours of admission.

Of course, the first days of detox are the most dangerous. Lehr and Maniace and Darling were dead before 72 hours had passed.

Still, DHCS said that these non-medical facilities did not run afoul of Brandon’s Law by claiming they offer medical supervision.

No hyperbole

The new law will provide penalties — such as loss of license — to dissuade operators from hyperbole, like claiming the staff marriage and family therapist is a certified addiction counselor and the like.

Enforcement action, as always, must begin with a complaint to DHCS (details on how to file complaints here).

The interpretation and enforcement will, of course, fall to the DHCS folks themselves. We asked if the new law will stop rehabs with IMS designations (and without!) from claiming they’re medically supervised.

State officials couldn’t tell us yay or nay by deadline. But Bates said that that’s clearly her intent. If more legislation is required, she’ll do what she can to make that happen — even as term limits mean her time in the state Senate will come to a close this year.

“Families should be assured their loved ones are properly cared for as they begin their journey to recovery,” Bates said in a statement. “Now that SB 1165 is law, I am hopeful more people will feel confident enough to enter treatment and overcome their addiction.”

Stop us if this sounds familiar.

These mental health homes have grown exponentially in California — but especially in Orange County. They provide 24-hour-a-day, nonmedical care and supervision to adults recovering from mental illness who need assistance, guidance or counseling. And the government’s well-intentioned eagerness to get mentally ill and addicted folks off the streets promises that thousands more will open in the near-ish future, with regulators paying more attention to the number of fire extinguishers than to ensuring programs actually work.

This may sound a lot like the (fraud-riddled) residential addiction treatment homes found in so many SoCal neighborhoods — but, technically, it’s not. Addiction treatment centers are licensed by the state’s Department of Health Care Services and must abide by an increasingly stringent (though not nearly stringent enough) set of laws aiming to protect vulnerable addicts from exploitation — many of which came in the wake of the Southern California News Group’s reporting on fraud, sexual assault and death on the Rehab Riviera.

These, however, are “social rehabilitation facilities” — a different beast, licensed by a different branch of state government. Social rehabs say they can treat the very serious behaviors that often accompany addiction — depression, anxiety, trauma, grief, schizophrenia, bipolar disorder, suicidal ideation, psychotic disorder, personality disorder, “dual diagnosis and co-occurring disorders,” and so on.

They tout “exceptional clinical teams” providing “a unique and effective combination of psychiatry, psychotherapy, and integrative therapy” at luxurious homes offering gourmet meals, swimming pools, yoga, meditation, massage, acupuncture, full gyms.

They’re often found in tract homes. They’re often run by some of the same businesses that run licensed addiction treatment centers. They often accept some of the same private-pay insurance. And they’re expressly non-medical, despite the very serious health issues they try to address — just like California’s licensed addiction treatment centers.

These DSS-licensed facilities must be certified by DHCS, but they aren’t licensed as addiction treatment facilities, a spokesman for the DSS said. If social rehab residents need addiction recovery services, the social rehab has to “ensure that those services are arranged.”

We asked for more clarity on any spillover between the laws governing addiction treatment and social rehabs, but that was not forthcoming from either DHCS or DSS by deadline.

Avoiding the teeth

The growth in these facilities has been stunning, especially in Orange County.

In the spring of 2013, there were just 96 “social rehabilitation facilities” licensed by the California Department of Social Services in the state. Only two of them were in O.C. Much larger Los Angeles County had 10, Riverside had three and San Bernardino had none, according to DSS data.

Fast forward one decade. Orange County has been declared the nation’s center of addiction industry fraud by the federal government. New laws have passed. And the number of social rehabs has tripled — to 286, with another 34 licenses pending. (View interactive map)

O.C., which had just two social rehabs in 2013, now has 61.

Los Angeles County — with three times O.C.’s population — also has 61. Riverside has 11. San Bernardino, 15.

But 12 more social rehabs have licenses pending in O.C., while only 10 more are pending in L.A. — which will make O.C. home to the greatest concentration of these facilities in the entire state of California.

It’s important to note that the overwhelming majority of them — more than two-thirds — sprang up in 2017 and afterward, when harsh light illuminated bad practices in the addiction treatment industry and new laws began rolling out to curb them.

Those new laws do things like require residential addiction treatment centers to adhere to standards set by the American Society of Addiction Medicine (imagine!), forbid them from misrepresenting or making blatantly false claims about the services they offer or where they’re located (imagine!), and require them to provide a “client bill of rights” to folks seeking treatment (can you imagine needing this at your doctor’s office?).

The bill of rights, by Sen. Tom Umberg and signed by the governor last year, spells out the right to safe, ethical, evidence-based services and must be signed by the client. Like other laws before it, it prohibits false or misleading advertising. Unlike other laws before it, it packs penalties of up to $20,000 per pop for violations and expressly allows clients, families and the California Attorney General to take providers who violate its provisions to court.

“That bill of rights put teeth into the addiction treatment laws,” said Bill Lyon, a Newport Beach resident who has been watching the growth of social rehabs with unease. “If you’re looking at opening one of these, you have all kinds of dos and don’ts and big fines for violations — but there’s much less involved with a mental health house.”

And it can be lucrative. After finishing 30 days or so of addiction treatment, billed to insurance, folks struggling with substance abuse can come to these mental health homes for another 30 days or so of mental health treatment, billed to insurance, pointed out Erica Keane, who is working with Lyon on the issue in Newport Beach.

Operators aren’t allowed to bill insurance companies for sober home living after a formal addiction treatment cycle is complete — but they could charge for this.

Worry

Lyon and Keane have been watching all this unfold with concern. Their city now has four licensed social rehabs, and one with a license pending — in addition to 39 licensed addiction treatment facilities and an untold number of sober living homes.

They worry.

In the spring, California voters will consider a ballot measure to create housing and treatment for homeless folks with serious mental illness. It will include a nearly $6.4 billion bond to build 10,000 treatment units and supportive housing.

Will these new facilities be as well-regulated as the current ones — which is to say, not very? Will Orange County again be home to a huge and disproportionate share of these facilities — far more than is needed to address local needs?

“They want to build 10,000 units, but they’re feeding them into a broken system,” Lyon said. “Are there that many qualified people that can run these? It’s a huge concern.”

California’s mental health system has been plagued with dysfunction since psychiatric hospitals were shuttered in favor of more friendly — and less expensive — community-based treatment centers decades ago, experts say. The pursuit of profit among private-pay mental health providers, and the sloppiness of state regulatory systems tragically ill-equipped to oversee them, fail patients and cost lives.

Many in Newport are still on edge over the death of Henry Lehr. Just days before a delirious Lehr bolted from a licensed detox, forced his way into a neighbor’s house and was killed, the detox operator was cited for eight deficiencies by state regulators. Its facilities are still open, and a new one has been licensed.

“What does it take to lose your license?” Keane asked.

Brandon Nelson committed suicide in a Sovereign Health facility that was supposed to treat his severe mental illness. His parents recently settled a wrongful death suit for $11 million with the defunct company, and have many of the same worries.

Allen Nelson, Brandon’s father, fears that many operators will swarm into the market for the wrong reasons — money — and tens of thousands of people will be funneled into substandard programs. “They know there’s not going to be any oversight. There’s not any oversight now. Given our experience, it could be very detrimental to many people,” Nelson said.

We reached out to several operators of social rehabs to chat about this, but folks weren’t keen to talk. Lawmakers were also mum — this is a hard one to juggle.

It’s clearly critical that we have more housing and mental health treatment for the 170,000 or so homeless people in California. But a radical increase in small, nonmedical facilities is not the answer.

When will we treat mental health and addiction as the illnesses they are? And when did we decide it’s OK to treat illnesses without medical personnel?

A Bakersfield attorney who Orange County prosecutors said built a $22 million empire by fraudulently billing insurance firms for urine tests that were either not needed or not completed has been sentenced to two years in jail.

Philip Ganong, 70, pleaded no contest Monday to 10 counts of submitting fraudulent claims for a health benefit at a chain of sober living homes his family operated in Southern California.

Ganong, his wife and their son collected urine samples from employees and patients staying at their homes. They created labs to test that urine. And they charged insurance companies, sometimes hundreds of dollars per sample, to analyze it. But often the tests were either not done or not needed, and the prescriptions were forged, prosecutors said at the time.

Ganong’s wife, Pamela, is awaiting a mental health competency hearing Nov. 28 to determine if she can stand trial on charges of submitting fraudulent claims for health benefit. Their son, William, died in a house fire in 2019.

A co-defendant, Susan Lee Stinson, pleaded guilty last week to two fraud charges and was sentenced to 34 days in jail.

The Ganong case highlighted the work of a special task force established by former District Attorney Tony Rackauckas. It was one of the team’s first cases in the aftermath of an investigation by Southern California News Group into abuses within the so-called “Rehab Riviera” in the Los Angeles basin.

The investigation found:

• Drug counselors and others could run sober living homes and some types of treatment centers without passing any kind of criminal background check. Even people convicted of drug crimes were allowed, under state law, to get a license to own and/or operate drug and alcohol rehab centers.
• Addicts and families considering rehab had no easy way to check the records of treatment centers, recovery homes or their owners.
• The state lags behind others in adopting reforms to crack down on treatment center operators who exploit vulnerable addicts and focus more on profits than on effective care.

Dear Gov. Newsom: Here’s a real California story for you. Ronald Reagan, Frank Sinatra, Phyllis Diller and Bob Hope are immortalized on Palm Springs’ Walk of the Stars — and so is reality TV celebrity Ken Seeley.

Seeley gained the national spotlight as a real-life superhero on A&E’s gut-wrenching “Intervention,” sweeping in as users spiral into addiction’s dark depths and often, against all odds, helping yank them out. His star power lent a special sheen to Seeley’s addiction treatment facilities — Ken Seeley Communities or KSC, doing business as Intervention911 — and attracts folks seeking similar miracles.

And so it was for Susan Rea of San Juan Capistrano. Despite repeated brushes with death, emergency room ordeals and stints in rehab, her 22-year-old son Dean just couldn’t shake perhaps the most dangerous addiction of all: to fentanyl. As you well know, Gov. Newsom, this synthetic opioid is some 50 times stronger than heroin and 100 times stronger than morphine. Just two milligrams of it — think a dozen or so grains of table salt — can kill.

Dean was more than his addiction. A skateboarder who loved the ocean. A surfer who taught kids to ride waves at Doheny Beach. A jokester with a gift for helping others see their own worth. A young man who had trouble seeing his own. He was diagnosed with bipolar disorder, generalized anxiety, ADHD and depression. It was 2021 and Rea was desperate to save her son’s life.

An acquaintance told Rea about Seeley and his operation in Palm Springs. Intervention911 could treat people with complex issues, routinely drug-tested clients and accepted her medical insurance.

They signed on and Rea drove Dean to Palm Springs herself. “I was looking for professionalism,” she said. “We all wanted Dean to get better.”

Dean entered detox at Intervention911 on March 13. Less than six weeks later, he was dead.

And this, Gov. Newsom, is where you — and California’s insurers and rehab regulators — come in. Dean’s compulsion to keep using despite the risks was very well-established. Therapists opined that he might actually have a death wish. Shocking details in Rea’s wrongful death suit against Seeley and Intervention911 suggest that so very many parts of California’s (tract-home-based, private-pay) addiction treatment system failed here — but as a parent, we get stuck on this:

If only California and its insurers required people like Dean Rea to see an addiction medicine specialist before checking in to non-medical facilities … if only a doctor had prescribed him buprenorphine, the gold-standard for managing opioid addiction, which cuts those compulsive cravings … if only he was encouraged, cajoled, convinced, even bribed to take it and keep taking it … if only, when things went dangerously south, he was taken to a hospital rather than allowed to wander off alone to die behind a gas station.

If only the private-pay piece of California’s addiction treatment system performed more like the public sector.

If only California bolstered oversight and professionalism along the Rehab Riviera.

If only, if only… Dean Rea might still be alive today.

Rea’s wrongful death suit just wrapped up in Riverside Superior Court with a confidential settlement agreement. Seeley and Intervention911 denied the allegations and admitted no wrongdoing. Its attorneys didn’t respond to our requests for comment, but in court documents, Intervention911 argued that Dean’s “own negligence was the sole and proximate cause” of his death.

Hundreds of pages of court documents vividly suggest weakness in the system itself. You can change that, Gov. Newsom. As you lobby us to approve a $6 billion initiative to expand mental health treatment, we implore you: Make sure California expands what works, rather than what doesn’t.  Pay attention to the painful lessons embedded in Dean Rea’s story.

It was a life-or-death story. As all addiction stories are.

Missed opportunities

There are three main steps in the rehab world — detox, residential treatment, then outpatient treatment/sober living. Dean spent much longer than usual in that first, intense, detox phase — about 10 days.

He had “dangerously lethal” substance abuse disorder, bordering on passive suicidality, staffers noted. Without a “contained” treatment environment, he was at the highest risk of relapse and lethal overdose on fentanyl.

“I don’t want to die,” Dean said, according to court documents.

But rather than following the familiar three-step script — sending Dean from detox to residential treatment, where he’d still be watched — Dean skipped from step one to step three, a sober living-type home called The Amado. There, he had far greater freedom to do as he pleased than if he were in that middle step, residential treatment.

At The Amado, he continued using fentanyl, court documents say. But that didn’t show up on his drug tests because, as Susan Rea would later learn, Intervention911 did not test for fentanyl.

Veils drop and souls are bared in these settings. Intense bonds form. Dean fell for Meredith Voelkel, a young nurse who struggled with alcohol, and she fell right back. But Dean continued to “struggle with high-intensity agitated depression” and habitually self-medicated with lethal doses of analgesics, case notes said. More than a month in, “post-acute withdrawal symptoms” — hopelessness, anxiety, recklessness, impulsivity, irritability, mania, worthlessness — continued to plague him. He reported “high craving levels.” He was “easily triggered and reactive” for wanting to use drugs.

Where a more medical rehab model might have gotten him to a doctor or a higher level of care, Dean got a visit with his mother. He felt closest to her because she was always there for him.

It was April 22, 2021, the day before his death. Rea treated him to a fancy dinner at a Japanese restaurant. They ate, they laughed, they talked about his plans for getting a license and a job. “He thanked me,” Rea said. “He said, ‘You’ve been hard on me because you love me.’ “

The next day, Intervention 911 was taking clients to Laguna Beach for sun and sand. Dean wanted to go — but he wanted to spend time with his mother more. After his friends left for the beach, mother and son went to breakfast at the nearby Denny’s, then had a family therapy session. Dean texted Voelkel a photo of him kissing Rea on the head. ““I’m so happy you and your Mom are good and you get to spend time showing how well you are doing,” Voelkel texted back.

Dean had a hankering for some shrimp and a Monster Energy drink, so Rea stopped at a supermarket and arrived with the goods around noon. She called for Dean at his bedroom door.

“He did not answer her, but she heard gurgling noises,” the suit said. “She tried to open the door, but the door was locked.”

Susan pounded on the door. Dean still didn’t respond.

She intercepted a staffer. He didn’t have a key and didn’t know where one was.

The worker broke down the door. Dean was sprawled on the bed. Next to him, tin foil stained with brown marks. Susan called 911 while the worker tried to revive Dean. “Don’t die,” Susan said, squeezing his hand. “Please don’t die. Come back.”

Dean stirred and was conscious by the time paramedics arrived, about 12:30 p.m. Dean needed to go to the hospital, the paramedics said. Dean refused; he didn’t want to pay for an ambulance.

The executive director told emergency workers he’d take Dean to the hospital himself.

Rea was in shock. “I had just seen my son turn gray,” she said. “I never experienced anything like that in a rehab facility. He had never gotten to that point in front of me.”

“What do I do?” she asked the staffers.

Leave, they said. They’re trained to handle these situations. They’d take care of Dean.

And so, at about 12:50 p.m., Rea left. She would never see her son alive again.

‘Loaded gun’

The executive director demanded that Dean hand over whatever drugs remained.

Dean refused. They argued. “I’ve had enough of your (expletive), I’m leaving,” the director said, storming off and leaving the marketing and admissions guy to deal with Dean, according to documents.

You can go to the hospital or you can get kicked out, the marketing guy said. There was no offer to drive Dean to the hospital. No way for Dean to get there safely on his own. No other options presented — such as a return to detox — and no one summoned Rea to help, the suit said.

If only, if only. “I would have turned right around,” she said. “I would have crawled over fire for him.”

The marketing guy told Dean to pack his bags. Dean’s phone buzzed as he obliged; it was his girlfriend, Voelkel, calling from the beach. He had overdosed and was leaving KSC, he told her.

Voelkel was stunned. She asked if anyone was with him, and the marketing guy said he was there. Voelkel assumed Dean was going to the hospital. “She did not believe KSC would kick him out when he was high and unable to make rational decisions,” court documents say.

But that’s what happened, the suit said. KSC “kicked Dean out to the street all alone and with a lethal dose of fentanyl in hand. … KSC essentially gave Dean a loaded gun and told him to shoot himself.”

In Laguna Beach, Voelkel started to cry. A counselor sat her down. “Look at that trash can over there. Do you see that piece of trash? You need to leave the trash in the trash can.”

Dean wound up behind the gas station just around the corner from KSC. He called Jon Wan, a friend on the beach outing. Dean was speaking nonsense, Wan said in court papers, and admitted to smoking fentanyl by the dumpster. Wan assured Dean they’d help as soon as they returned to Palm Springs.

Meanwhile, Rea was calling multiple people, multiple times, for updates. She couldn’t reach anyone.

Dean stopped answering phone calls and texts sometime after 2 p.m. Concerned, a staffer asked the executive director to check on Dean. “I’m no (expletive) babysitter,” the executive director responded, according to the suit. “He’s been kicked out.”

It was after 5:30 p.m. when Dean’s friends returned from the beach. Wan beelined to the gas station and found Dean lying on the ground. Wan rolled Dean over. Blood leaked from Dean’s eyes. His face was gray. Ants crawled on him and flies buzzed around him.

Wan called 911 and raced back to The Amado to grab Narcan, the opioid-overdose antidote. Others came with him to help. But it was too late.

The executive director said Dean was not a client when he died. No one was to contact Rea. They’d let the coroner deliver the devastating news.

‘Breach of duty’

In dry legal language, it’s this:

“KSC breached its duty to Dean by kicking him out of its facility knowing his strong addiction and overdose history with fentanyl; his suicidal ideation; his diagnosis of having several mental health disorders; his prior use of fentanyl that day which resulted in paramedics being called to attend to him; knowing he continued to possess fentanyl; knowing he did not have any safe transport to a safe location; and knowing he was homeless,” the suit said.

“His death was highly foreseeable under the circumstances.”

The lock on his bedroom door. The lack of supervision. The failure to test for fentanyl. “Below the standard of care,” the suit said.

In declarations to the court, more than a dozen people laid the blame for Dean’s death at KSC’s feet. They should have gotten Dean to a higher level or care, or called police, or tried to put him on a 5150 psychiatric hold if he refused to hand over his drugs, they said. You never discharge someone in that condition without referrals.

“Some of the main lessons here are the importance of making sure people are in the appropriate level of care, and the importance of having trained, experienced people in charge,” said Christina Denning, Rea’s attorney, after the case closed.

“There’s so much turnover in these facilities. Important decisions were made by the marketing admissions guy and the executive director — management people, marketing people. They’re not doctors. They’re not therapists.”

We applaud California’s Bridge program, helping emergency departments become primary access points for addiction treatment. We applaud California’s hub-and-spoke system, increasing the availability of medication-assisted addiction treatment to people who need it. But it’s astonishing that close to half the state’s treatment providers  — 41%, according to federal data  — still eschew life-saving medication like buprenorphine. They equate a drug that can save your life with one that can kill you.

Might buprenorphine maintenance have spared Dean’s life? Dr. Randolph Holmes, who deals with government and public policy for the California Society of Addiction Medicine, counsels us not to be naïve.

“Many people resist treatment, even from doctors, and I spend a lot of time every day trying to convince people to start life-saving medications,” Holmes said.

But public providers funded by MediCal must either have medical providers, or be able to refer patients for medication-assisted treatment. There’s no such requirement for the private sector.

“CSAM has been trying for years to get legislation passed and signed to mandate access to medications for all,” Holmes said. “It is paradoxical that a person can get better access to evidence-based care in the public sector than in the private sector.”

If only, if only. Gov. Newsom, raise the bar for this industry in California.