The idea seemed simple, elegant and eminently logical – but in Sacramento, there may be no such thing as a simple idea.
Assembly Bill 572 would move one of the state-paid inspectors of addiction treatment centers from Sacramento to the the epicenter of the drug rehab industry, Southern California.
“I’m a former resident of an Orange County treatment center, with six years of sobriety,” a young woman, a recovering alcoholic, told state senators last week. “The bad actions of residential treatment facilities can be a matter of life or death for people like me. Personally, my insurance was billed for a substantial number of drug tests I never took. A staff member relapsed yet continued to be employed. In the end, she took down three of my fellow patients with her.”
The woman said she’s known addicts who were lured to specific treatment centers by so-called body brokers, and that some addicts were given drugs prior to entering rehab in schemes to ensure the brokers got paid.
The state of California remains oblivious – or tolerant – of all this, and someone with the authority to act needs to be watching, the woman and others told the Senate Health Committee last week as they tried to make the case for the bill.
AB 572, by Assemblywoman Sharon Quirk-Silva, D-Fullerton, would shatter the California Department of Health Care Services’s regulatory model by stationing a single inspector in or near Costa Mesa – home to the densest concentration of licensed addiction treatment facilities in California outside of Malibu.
It can take up to a 18 months for a Sacramento analyst to respond to a local complaint, and that’s only when the people complaining can tease out precisely who to complain to, and how to contact them, Quirk-Silva said. This would be a pilot program, funded by Costa Mesa and other local cities, that would take a small step toward resolving compliance issues in the rehab industry that threaten lives and upend neighborhoods.
But the bill got – if not quite the kiss of death – a bite of the poison apple that will put it to sleep for a while.
For…
Nancy Clark has run her own treatment program in Costa Mesa for 27 years, and worked in recovery centers for 44 years. She agrees that the state must do a better job of monitoring the lightly regulated industry.
“When a program becomes licensed, it’s not visited again by an analyst for two years,” Clark said. “A lot can happen to crumble the operation of a facility in two years without supervision.
“We need to be able to establish a closer rapport with the Sacramento analysts, and having them so far away just doesn’t work,” Clark added. “We can’t get returned phone calls. They’re busy covering wide areas.”
More than 80 people have died in California licensed treatment centers over the past five years, a figure that doesn’t include those who lost their fights with addiction in unlicensed sober living homes, which are not regulated by the state.
“We would welcome the addition of someone close by so our families losing loved ones would have someone they can directly talk to about the problems and the issues we’ve had,” Clark said. “Human trafficking is the biggest issue we face right now… It’s an epic, alarming situation. And we would welcome this bill to help bring a solution.”
Costa Mesa Mayor Katrina Foley urged lawmakers to act. “This bill is not only about inspections but about public health and public safety and protecting people who are vulnerable from abuses,” Foley told the senators. “We are at the epicenter of this industry, and our community needs your help. The need for boots on the ground is critical.”
Those boots won’t be coming soon.
… Against
Quirk-Silva’s bill – like a separate proposal to forbid the patient-brokering and human trafficking described by Clark and the young woman – garnered stiff industry opposition and will be resurrected in a different form in the next legislative session.
“The system right now isn’t broken,” said Sherry Daley of the California Consortium of Addiction Programs and Professionals.
“There isn’t merit for bringing an investigator there,” Daley said, adding that just 38 official complaints were received from an area with more than 1,100 licensed centers.
“That (low number) shows it’s working. What would that investigator be doing in the down time? If an investigator is hired locally, they might want to apply a different standard than one that works in Sacramento with the rest of the staff.”
Curtis Child from Disability Rights California agreed, and asserted that the bill springs from not-in-my-backyard-syndrome.
“We do believe that uniformity of enforcement is critical,” he said. “As we have seen in a number of these bills, the concern often comes from neighborhood opposition to these treatment programs.”
The Southern California News Group recently investigated the addiction industry and found it peppered with financial abuses that bleed untold millions from public and private pockets, can upend neighborhoods and often fails to set addicts on a path to sobriety. The revolving door between detox centers, treatment facilities, sober living homes and, often, the streets generates huge money for operators who know how to game the system. And even obvious fixes can be hard to make.
California’s lax regulation of the industry has been attacked for myriad failings over the years. But its abandonment of the “certificates of need” system – where would-be rehab operators must prove there’s a local demand for their services before opening – is a key reason why Southern California has become known as The Rehab Riviera, importing addicts from other states.
Until recently, California had just 16 inspectors to oversee nearly 2,000 licensed addiction treatment centers. After blistering criticism, the Department of Health Care Services beefed up its ranks, adding 14 new inspectors – nearly doubling the force to 30. Four will be dedicated, for a limited time, to issues in Los Angeles County.
With 10 million people, LA County has 509 licensed facilities – one for every 19,646 residents, according to recent state data.
Orange County’s concentration is far denser. With just 3 million people, it had 413 licensed facilities – one for every 7,264 residents.
Try again
Committee members – including vice-chair Sen. Janet Nguyen, R-Garden Grove – appeared to feel O.C.’s pain and be open to Quirk-Silva’s next attempt.
“It could be true that a higher-profile local presence could contribute to quality of life without jeopardizing quality of care,” said Sen. Josh Newman, D-Fullerton.
“If there is fraud, abuse or mistreatment of patients, those facilities’ licenses should be taken away,” said Sen. Ed Hernandez, D-Azusa, chair of the committee. “They should be prosecuted. No one should be put under those circumstances. Where I have concern is, now you’re going to start sending out inspectors to various communities…. I believe it should be centralized. Fix the system.”
Quirk-Silva insists that one size definitely does not fit all, and was surprised by how adamantly officials felt about centralization in Sacramento. But she remains upbeat, promising to meet with people from all sides in the coming months and craft a bill that will work for everyone.
“We’ll continue on the pathway to get a rep down to Orange County,” she said. “My attempt is not to close down good actors. We do need these services. But the state has to be pushed to change the way it operates. A lot of the time, new ways to look at how to solve issues aren’t necessarily embraced by the bureaucracy. People like to stay in the comfort of the way they’ve been doing things.”
Sitting down face-to-face over the coming months might bring some relief even before a revised bill is introduced, she said – and compliance officers are going to be a lot more alert.