Addiction treatment facilities operating on a provisional license after state investigations

Recent operations at one of Montana’s largest addiction treatment companies included shoddy admissions practices, failure to report a patient death and safety concerns in a timely manner, and unlicensed detox and withdrawal practices, according to state investigations completed in mid-October.

Three high-intensity clinical facilities run by Recovery Centers of Montana were inspected by the state health department’s Office of Inspector General beginning in late August in response to complaints that have not been publicly specified. One of the facilities, located in Clinton, voluntarily closed in September following the death of one of its patients, as Montana Free Press previously reported. After a temporary hold on new admissions, the state is now allowing the company to operate its other two facilities in Hungry Horse and Columbia Falls on a provisional 90-day license and a corrective plan directed by licensing officials, a copy of which was shared with MTFP by the health department.

In the inspections spearheaded by investigator Stephanie Galle, state officials reported interviewing 60 staff members and 75 clients and reviewing 58 client records and 81 staff records. Investigators found that many patients at all three facilities lacked a chemical dependency evaluation upon admission, and dozens more had never filled out an application for the program. Of 27 patient files reviewed from the Clinton facility, none included written documentation that the admission had been reviewed by a licensed social worker, therapist or addiction counselor. 

Citing interviews with current Recovery Centers staff, inspectors said employees often did not receive information about incoming patients’ “needs and issues,” and that chemical dependency evaluations were regularly completed only after admission. The files of three Clinton clients included disclosures of suicide attempts days before they came to the facility, but no patient records included the company’s required suicide risk assessment at the time of the state’s inspection.

“Staff state that sometimes all they know about new admits is their name and where to pick them up for transport to the campus,” inspectors wrote. “Other times, the clients just show up on campus and staff have been instructed by leadership to just admit them.”

At the facility in Columbia Falls, staff said, chemical dependency evaluations for patients were administered by an external licensed addiction counselor, and staff often felt the evaluations were “inaccurate, embellished, and copied and pasted from other evaluations,” the inspection said, adding that staff “… feel if they do not read the evaluation, then they cannot be held liable for the contents of the report.”

The Clinton report indicates that the substandard admissions processes may have put staff and clients at risk. In one July incident, a patient reportedly “became belligerent” and threatening toward a staff member who was attempting to do an intake process with him alone in her office. The patient, the state report said, had been “transported to the facility by one of the owners of the program that bailed him out of jail” and was reportedly high on methamphetamine at the time of his intake. 

The staff member “was so afraid of what he would do if she tried to leave that she was trapped in her office with him for 2 hours,” the report states. “There was no landline phone in her office to call for help and nobody came to check on her during this time.”

Two weeks later, in late July, another staff member was processing an intake with a different male client when he sexually assaulted her, according to the state inspection. That client was reportedly “highly intoxicated and had been released from jail” and the staff member also lacked a landline to call for help, and so texted colleagues from her personal cell phone. That incident, investigators said, “was not reported to [state inspectors] or law enforcement.”

The patient death in mid-September was also not reported to inspectors until state surveyors arrived at the Clinton campus two days later. Even then, the investigation said, one staff member “initially denied there were any new serious incidents to report.” 

The state inspection also said all three facilities, labeled as 3.5 level facilities based on guidelines published by the American Society of Addiction Medicine, were providing unlicensed “withdrawal management services” by admitting clients who were intoxicated or high. The state wrote that some clients told staff members they were experiencing tremors, nausea, headaches, hallucinations, and sweats while detoxing from alcohol, methamphetamine, fentanyl and other intoxicants.

At the point of his admission on Sept. 7, the client who died later that month was recorded as having a .313 blood alcohol content, a dangerously high level, according to state inspectors. His intake evaluation said he had a history of seizures and had been experiencing shaking, sweats, and high blood pressure for two days. One staff member reported to her supervisor that she was uncomfortable with the client being there in his condition. Roughly eight hours later he was taken from the facility to an emergency room to detox. The patient’s cause of death on Sept. 16 had not been publicly released as of Nov. 2. MTFP is withholding his name to protect his privacy.

In a Thursday phone call, RCM co-founder Jim Driscoll disputed the state’s characterization of a patient sexually assaulting a staff member, saying that while the patient’s actions and words were inappropriate, they did not rise to the level of assault. He agreed with the state’s conclusion that clients should receive chemical dependency evaluations and medical clearance before arriving at the facility and said that practice will be implemented.

“We’ve never brought anyone in for treatment that didn’t need help. But our staff were so eager to help people that they were bringing them in prior to having an eval. And sometimes without even an application. People would just show up,” Driscoll said.

While RCM does not plan to reopen the Clinton facility in the foreseeable future, Driscoll said, the company is beginning to admit new clients to its programs in Hungry Horse and Columbia Falls with the goal of having 20 patients in each location by the end of next week. Driscoll said the company is “actively hiring and recruiting” to fill additional positions at the remaining two facilities and is “really excited” to continue operations.

According to the state’s plan of correction, RCM is barred from admitting or housing patients who are “experiencing acute intoxication, acute withdrawal, are medically unstable or in need of withdrawal monitoring” and transporting any patient who “appear[s] to be intoxicated or under the influence of substances to the facility for admission.” The company is also required to complete proper admissions protocols, correct staff-to-patient ratios, and immediately report any serious incidents to the state. 

The correction plan document, dated Oct. 18, states that the department “will complete periodic unannounced site inspections during the provisional license period to determine compliance” with its plan and state regulations. 

“It is the department’s intent in issuing this [plan of correction] is to assist the facility to come into compliance with the applicable rules and regulations. This plan must be adhered to according to department direction. Failure to do so within the provisional license may result in negative licensing action,” the document states.