Big addiction treatment “campuses” aren’t allowed in residential neighborhoods without special permits. But providers in California get around that by clustering many small homes together — one treating 30 users at a pop! — and regulators haven’t raised an eyebrow.
It took almost three months for them to investigate serious complaints — like patient deaths in addiction treatment homes — and more than a year to probe less serious complaints. That lag means problems may fester and put patient safety at risk — but it’s a vast improvement over a few years ago.
And when the state brought its weight to bear on unlicensed homes illegally advertising or providing services that require a license, regulators didn’t always bother to venture out to see for themselves what was actually happening, and/or didn’t follow up to make sure the folks they told to stand down actually stood down.
On Thursday, Oct. 24, the State Auditor released a long-awaited study on how California regulates its (fraud-prone) addiction treatment industry. It confirmed that there are serious issues, and that Orange County in particular and Southern California in general are the epicenters, and that there are steps lawmakers can and should take to make things better.
“We have a road map here,” said Assemblymember Diane Dixon, R-Newport Beach, who requested the audit more than a year ago. “It confirms key concerns that are now validated by third-party analysis: Investigations take too long, sometimes don’t even happen, and there can be infrequent follow-up. It will help us shape legislation based on these facts.”
Dixon is assembling lawmakers Friday, Oct. 25, to push the governor and DHCS Director Michelle Baass for greater accountability and an increase in the number of inspectors. “We’re coming together for solutions,” she said. “We want people to get well.”
In its response, Baass said the department is already implementing many of the auditor’s recommendations and “is committed to robust oversight of residential treatment facilities to ensure Californians receive safe and high-quality care.”
It’s a start
While we’re generally big fans of the analytical eggheads in the Auditor’s office, this examination treaded rather lightly, mainly asking how well the state Department of Health Care Services does what it has been told to do, rather than probing what it actually should be doing to ensure patient safety, avoid giving licenses to fraudsters and maintaining neighborhood peace.
After covering the ugly side of this industry for nearly eight years, many of our burning questions remain beyond its scope. Is it wise for these explicitly non-medical facilities to be providing detoxification services — which can be medically fraught and deadly — in tract homes without a doctor present? Should detox services be provided in this setting at all?
Why does the state require only 30% of the alcohol and drug counselors on staff to be licensed or certified? Can you imagine a hospital with that kind of ratio?
Why are there criminal background checks for hairdressers, but not for addiction center workers? Why, when deaths in state-licensed treatment programs have nearly tripled between 2012-13 and 2020-21 (from 21 to 61, according to data we’ve obtained from DHCS), didn’t the auditor even ask about that?
Back in 2012, a blistering study titled “Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results” took no prisoners. It was done by the California Senate Office of Oversight and Outcomes and the department overseeing addiction treatment was dismantled in its wake — and DHCS was born. To, like, fix things. Perhaps it’s time to examine how well that’s worked out?
One step at a time, say the electeds who’ve been eagerly awaiting this report.
“Based on a preliminary review, while the audit was limited to only licensed facilities and the proposed recommendations would not solve every issue, they are a starting place as it relates to preventing overconcentration and improving oversight,” Wendy Bucknum, Mission Viejo councilmember and co-chair of the California Sober Living and Recovery Task Force, said by email.
“More importantly, these findings identify serious problems, a need for greater local control, and make it more difficult for the state legislature to wholesale reject much needed and common sense reforms, as we experienced in the previous legislative cycle. The audit also points out a jaw-dropping fact – despite the hundreds of millions of taxpayer dollars being poured into these programs and bad actors taking advantage of vulnerable patients in some cases, there is no measurement or data to demonstrate whether the treatment is even effective.”
For Sen. Tom Umberg, D-Santa Ana, the audit confirms what he and other lawmakers have been saying for years: DHCS is seriously under-sourced, takes forever to investigate complaints, can’t do frequent-enough inspections or enforce the laws.
That’s why he championed Senate Bill 913, an eminently logical bill (that had stunningly bipartisan support!) and would have empowered local governments to help overburdened state regulators handle complaints and inspections. It died, but Umberg remains convinced it’s part of the answer.
“The state is resource-depleted right now,” he said. “This is not a panacea, but one mitigation is to allow the locals to do some of the work the state is not doing. It’s not just the communities that suffer, it’s also the individuals in these facilities. It’s a disservice to them.”
Vindication of sorts
In Sacramento’s halls of power, the perception has long been that folks in O.C. who complain about rehabs are a bunch of cork-sniffing whiners. While the audit didn’t mention the many federal prosecutions for body brokering and insurance fraud currently underway in O.C. and L.A., it did back up some general assertions.
“Some residents in Orange County have expressed concerns that an overconcentration of treatment facilities is negatively affecting their communities, and we did find that Southern California and other specific geographic areas throughout the state contain groupings of treatment facilities,” it said.
It called out, though not by name, three side-by-side facilities on East Adams Street in Santa Ana run by New Life Treatment Center, which can house up to 18, and a compound of five luxurious homes around Country Rose Circle in Encinitas run by the AToN Center, which can house up to 30.
“Our 10-acre campus has pathways connecting the homes, ensuring privacy and tranquility,” AToN’s website crows. “AToN Center is nestled between the Pacific Ocean and the upscale neighborhood of Rancho Santa Fe. Expansive gardens and decks have views of the nearby coast and surrounding mountains. Other highlights of our beautiful accommodations include an onsite gym, Peloton bikes, tennis court, sand volley court, saltwater pools, dry sauna, cabana, fountains, fire pits, multi-jet outdoor shower, and multi-hole putting green….”
Campuses, or what Dixon might call mini-institutions (which the state has been trying to move away from), can happen when each house in a cluster is licensed separately for six or fewer residents. More than six would trigger higher insurance requirements and a permitting process that could sink the whole operation.
Turns out that, while California law has separation requirements for other types of group homes, it does not have any for addiction treatment centers. But that’s not etched in stone.
“The Legislature could potentially change state law if these facility concentrations are not consistent with the law’s intent, which we believe was to integrate residents of these facilities into the communities and to provide for sufficient numbers and types of treatment services to meet local needs,” the audit says.
To address some of these issues, the auditor recommended that DHCS fill its vacant positions, improve the timeliness of inspections and complaint investigations, do additional site visits and follow up with unlicensed facilities to ensure they stop providing or advertising services beyond their reach.
“We know more than we did yesterday,” Dixon said. “The audit called out what’s failing — it’s just unacceptable, these nonresponse investigations — and we have a path forward to go after what we don’t know. Are people getting well? Data is powerful. Until we have data, we’re just swatting at clouds.”
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