Admissions on hold at Montana addiction treatment company

State inspectors have required one of Montana’s largest substance use disorder treatment providers to stop accepting new patients following the September death of a patient. A complaint-based investigation by the state health department is underway.

Recovery Centers of Montana, a for-profit limited liability company that has operated in Montana since 2020, runs three addiction treatment facilities in Clinton, Hungry Horse and Columbia Falls. Its recent plans to open a lower-level inpatient facility for women in St. Ignatius are now on hold, according to one of the company’s co-founders.

Collectively, RCM is licensed to operate 163 beds for men and women with substance use disorders. Its existing services in western Montana are certified by the state as 3.5 level facilities — a type of licensure between outpatient treatment and intensive hospitalization based on a scale created by the American Society of Addiction Medicine.

The future of those beds, which addiction experts say fill a critical role in Montana’s addiction recovery landscape, is now unclear. RCM co-founder and co-CEO Jim Driscoll confirmed to Montana Free Press in early October that none of the organization’s facilities are currently allowed to accept patients, a restriction that Driscoll said the state implemented shortly after the Sept. 16 death of a man at the Clinton facility, which has been in operation since January 2023.

A death certificate listing the patient’s cause of death was not complete and available Tuesday morning. MTFP is not naming the patient to protect his family’s privacy. In the aftermath of the death, Driscoll said, the company opted to transfer or discharge the remaining Clinton facility residents, a decision he said state inspectors with the Department of Public Health and Human Services supported. The other two licensed facilities remain open.

While Driscoll said the man died “of natural causes,” he acknowledged that the event was “part of the pause” in admissions at the other two facilities. He said the state’s decision to cease admissions was also in response to inspectors’ assessment that RCM staff were too lenient in accepting patients, even if they met evaluation requirements for that level of care.

In an Oct. 9 phone call, Driscoll called addiction “an epidemic” and said that with so many people seeking help, “sometimes you have to be more organized in how we bring people in for the safety of them and our clients and our employees.”

“You just want to help everybody as fast as you can. The reality is, you need to follow procedures and we look forward to getting back on track,” he said.

Driscoll noted that RCM’s facilities mostly treat patients covered by Medicaid, rather than private insurance, a low-income population that often has fewer options for treatment and may face other societal barriers to overcoming addiction.

In written a statement to MTFP on Oct. 3, state health department spokesperson Jon Ebelt did not confirm that the state’s Office of Inspector General had ordered RCM to stop accepting new patients. Rather, he said, inspectors are in the process of conducting a “survey” into a complaint regarding the company and will publish related documents when the survey is complete.

“We do not otherwise comment on pending surveys,” Ebelt said.

Treatment providers and other service providers expressed disappointment and some dismay at the restriction. Brett Schandelson, director of the Office of State Public Defender, said many of his agency’s clients have generally struggled to find addiction treatment beds in the state, even when RCM was accepting new patients.

“It’s a terrible situation for Montanans and those in need,” Schandelson said of RCM’s pause on admissions and operations of the Clinton facility. “There’s not enough providers as it is, so this is a loss.”

State inspectors reviewed all three RCM facilities in May as part of a routine licensure renewal process. Though not clearly related to the September decision to pause admissions, the published inspections identified many lapses in compliance with state rules and requirements at the Clinton and Hungry Horse locations.

Among the shortfalls, inspectors found that RCM staff at the men’s center in Clinton had failed to develop and update treatment plans with multidisciplinary teams, complete treatment plans within 48 hours of admitting a patient, document when some patients were expected to complete treatment, or properly review treatment plans every seven days. The state review also found that other patients, some of whom had been at the facility for months, had never signed their treatment plans.

The state also assessed 10 patients’ “continuing care plans” for discharge from the Clinton facility. All were found inadequate to licensure requirements in some way, including failure to list contact information for clinical staff, record current medications and dosages, and document mental and psychiatric care received during treatment.

Many of the same issues were identified at the Hungry Horse facility, which treats female patients. Inspectors also faulted both locations for unsanitary and sometimes unsafe conditions: some cabins at the Clinton facility lacked smoke detectors and fire extinguishers, some had hornet nests and bird nests in the entry areas of housing units, some showed signs of water damage. A “pungent urine odor” in some cabins and “a buildup of grime, debris and soap scum” on “floors, bathrooms, kitchens, and walls” was also noted.

In a written plan of correction for the Clinton facility submitted to the state at the end of May, RCM promised to improve staff training and staffing levels, correct documentation errors and increase oversight of treatment plans by an on-site administrator. The plan also said the company had purchased fire extinguishers, smoke alarms and other missing materials for the cabins and planed to a hire a new employee for “deep cleaning” of all the living areas.

Lenette Kosovich, the recently retired CEO of the Billings-based treatment facility Rimrock, who reviewed the state’s May inspections at the request of MTFP, said the reports raised concerning findings about RCM’s operations.

“These foundational requirements are what set the programs up for success[,] or not,” Kosovich said. Properly planning to discharge patients, in particular, she said, “is what really determines if the patients are obtaining some success in treatment and helps set the direction for their future succes.”

Driscoll did not say when RCM might be allowed to restart admissions or reopen the facility in Clinton. But he maintained that the organization is dedicated to working with the state to improve operations and continue serving patients.

“I’m unaware of any ethical issues at all,” Driscoll said, reiterating that state inspectors had flagged “how enthusiastically” staff were accepting clients. “From every indication I’ve seen, it’s just about having more control of policies and procedures.”