Closure of inpatient detox facility forces Tri-City addicts back on the streets

Dr. Jeffrey Allgaier sees the dangerous cycle repeat itself on a regular basis.

Addicts hooked on meth, heroin, alcohol and other drugs come into his Kennewick clinic, Ideal Option , wanting help to get sober.

Many need inpatient care at a detox facility to safely begin the process of getting clean. But the only such facility locally, run by Tri-Cities Community Health, was shut down at the end of June.

The closure means addicts are being forced back onto the streets with the hopes that they will follow treatment plans, Allgaier said. That leads to overcrowded hospital emergency rooms, long hospital stays, increased crime and possible deaths.

Addicts have to find the potentially life-saving help elsewhere in the region, something that can be extremely difficult because of health insurance restrictions and long wait lists.

A majority of the more than 1,000 patients at Ideal Option, the only full-service outpatient addiction medicine clinic in Eastern Washington , are on Medicaid.

The only inpatient detox facility in Eastern Washington that currently accepts Medicaid is in Yakima, where it can take months to be admitted.

Those wanting to get sober are usually not admitted to hospitals unless they are suffering life-threatening medical emergencies or severe confusion, said Allgaier, who is also an emergency room doctor at Kadlec Regional Medical Center in Richland.

With no detox options in the Tri-Cities available, Allgaier has seen patient numbers increase at Ideal Option, leaving his team of doctors to work tirelessly to come up with creative and intensive outpatient treatment plans, he said.

“There’s at least five patients I have seen in the last week that we have had to do patchwork in order to take care of these folks because the services simply don’t exist,” he said.

State audit ‘didn’t go well’

A state audit by the Department of Social Health and Services showed several key deficiencies within the detox center.

“The detox audit didn’t go well,” said Dell Anderson, director of behavioral health services for Tri-Cities Community Health.

It showed patients weren’t properly assessed when admitted, policy and procedures were outdated and not followed, there was no documentation of required staff training and the program manager was not certified to hold the position.

The biggest problem auditor Julian Gonzales found was that the facility was treating patients with mental health and chemical dependency issues, something it was not certified to do.

The facility had 12 beds, eight of which were designated for people with mental health issues. The other four were reserved for people with chemical dependency problems.

The mental health beds generated more money through government health insurance than the chemical dependency beds, Anderson said. That money was used to run the facility.

The facility has been housing both types of patients for years and it came as a shock that it was not in line with state rules, Anderson said. The issue hadn’t come up in previous audits.

“It’s the reason we had to shut down. We lost that funding source,” Anderson said. “That’s how we operate. Trying to carry on with just four beds was impossible.”

Benton County Commissioner Jerome Delvin contacted state Sen. Sharon Brown’s office to inquire whether Gonzales was right when he told the facility it couldn’t house mentally ill patients and addicts together.

A senior member of the Senate Human Services, Mental Health & Housing Committee determined Gonzales may have misinterpreted the law and that the facility could continue to serve mentally ill patients, according to emails obtained by the Herald. The detox center would have to meet requirements to get single-bed certifications to provide services.

Anderson admitted the facility needed to change things if it were to remain open.

The auditor reviewed five patient files and all of them showed no documentation that patients were assessed before they were admitted. The records also didn’t document that patients had been admitted or their discharge criteria.

“It’s a good indicator that we were not doing the work that is required,” Anderson said. “I don’t have an excuse for that.”

Some mistakes were fixed quickly, like printing online certificates that showed staff was properly trained and having employees sign confidentiality agreements, which was not done before, Anderson said.

The program manager was qualified to run the detox center, but did not have the proper certification under the job description, he said.

The position called for the program manager to be a certified chemical dependency professional and mental health counselor. The manager was a state certified clinical social worker.

Officials decided to shut down the detox center before reading the audit, which was presented to them June 29, Anderson said. The decision was based solely on the fact they wouldn’t have the funding from the mental health beds.

The center officially closed June 30, one day after the audit was presented.

If not for the funding issue, Anderson said, staff would have worked hard to correct the mistakes and keep the detox center open.

“The mistakes that were found during the audit were not mistakes that would have closed a facility,” Anderson said. “But they were significant.”

What does the future hold?

Ken Roughton, director of Greater Columbia Behavioral Health, the agency that will take over providing behavioral health services to the area in April, is committed to having a detox center in the Tri-Cities, he told the Herald.

GCBH will also be responsible for providing a range of behavior health services to 10 counties in the region.

Officials are already looking at ways to reopen the facility and get it properly licensed, Roughton said. The plan right now is to possibly use the same building.

“One of the things we will have to fix right away is having a detox center,” Roughton said. “It’s needed.”

Allgaier — who works with 13 other physicians at the three different Ideal Option locations — considered taking over the contract to the detox center, but the idea wasn’t financially viable and presented other roadblocks.

His vision is an inpatient medical detox facility run by medical staff, he said. The facility would accept Medicaid and Medicare, which is uncommon.

“We don’t want a facility only willing to take private health insurance,” he said.

The closed detox center was a “subacute” facility, meaning staff didn’t provide medical services like prescribing medication.

A medical detox allows doctors to monitor for seizures, heart arrhythmia problems and make sure medications are taken as prescribed, Allgaier said.

The inpatient facility would also need “robust” outpatient treatment plans following detox, something that wasn’t always done in the past and created a revolving door at the now-closed facility, Allgaier said.

Allgaier would also like to make it easier for patients to get admitted to inpatient facilities, he said. They were routinely turned down at the detox center when it was open, which was frustrating for doctors and those looking to get clean.

The doctor recommended having patients in need of a medical detox stay between three days to a week before starting outpatient care.

“I can’t tell you the countless number of times we have had the inability to get patients into detox simply because there were no beds available,” Allgaier said. “Even when detox was here, it wasn’t here.”

This story was originally published August 23, 2015 at 10:17 PM with the headline "Closure of inpatient detox facility forces Tri-City addicts back on the streets."