Northwest addiction treatment centers will remain open after state inspections

A company that operates 86 treatment beds between two addiction treatment centers in northwest Montana will stay open following state investigations into poor admissions practices, inadequate documentation of treatment plans and a failure to appropriately report serious incidents.

Inspectors with the state health department decided in January to extend the license of Recovery Centers of Montana’s women’s facility in Hungry Horse until January 2025. The men’s facility in Columbia Falls, however, will operate on a provisional license until July 2024, with state officials raising concerns this month about patients being admitted while high or inebriated and the staff’s failure to report an incident where residents were allowed to remain at the facility after making racist threats toward another patient.

In a Thursday phone call, RCM’s co-founder and co-CEO Jim Driscoll said many of the state’s lingering issues were being addressed at the Columbia Falls facility, but he disagreed with some of the characterizations and findings in the most recent report. Overall, he said, he was pleased with the progress of both treatment centers and added it had been “a great partnership with the state, working on making us a better organization.”

He said both the women’s and men’s facilities have waiting lists and are looking to hire additional peer support staff members, licensed addiction counselors and case workers.  

“We’ve built a really strong team that’s providing really strong treatment and services,” Driscoll said.

RCM, one of the largest addiction treatment providers in the state that often serves Medicaid-eligible, low-income clients, has navigated a turbulent year, resulting in the state mandating improvement plans and putting the facilities on 90-day provisional licenses last fall. Both of its facilities are licensed as high-intensity treatment centers based on guidelines from the American Society of Addiction Medicine.

In September, company owners opted to close its remote men’s facility in Clinton, just west of Missoula, citing staffing issues and other operational challenges. The decision came after a 47-year-old patient died that same month, an incident that Driscoll previously described to Montana Free Press as a tragic accident. MTFP is withholding the name of that individual to protect his family’s privacy.

After that patient’s death, state inspectors directed the company to pause admissions at all three of its facilities, in part because they said staff at the Clinton facility had not reported the death in a timely manner. Driscoll has said that the company’s subsequent decision to close the Clinton treatment center was unrelated to the patient’s death and that many of the remaining staff and clients were transferred to the remaining two facilities in the northern part of the state. 

In a letter to Driscoll dated Oct. 18, a copy of which was shared with MTFP by the state health department, licensure officials said the department’s intent in issuing a plan of correction and provisional licenses was “to assist the facility to come into compliance with the applicable rules and regulations,” following reviews of client and staff records and interviews. Failure to adhere to the plans, the department wrote, “may result in negative licensing action.”

In December reviews — made public by the state licensing division in January — inspectors continued to document insufficient staff training and treatment plans, and some instances where staff were admitting and transporting patients who were still under the influence of substances or experiencing acute withdrawal symptoms. Neither facility is licensed to handle medical detox.

“The program admitted and house[d] individuals that were experiencing acute intoxication, acute withdrawal, were medically unstable or in need of withdrawal monitoring,” inspectors wrote about the Columbia Falls facility in mid-December. The review cited one client who was “transported and admitted while under the influence and admitted into [the] facility while in withdrawal” at the end of October only to be discharged two days later. 

In previous interviews, Driscoll agreed that some of the admissions practices flagged by inspectors have been problematic but explained the issue as resulting from his staff’s desire to help people.

“You’re just so tempted to help everyone all at once,” Driscoll said in October. However, given the company’s high-needs clientel, he said, “it’s more important that we are more careful about how to bring our clients in and when.”

Following the company’s most recent inspections in January, state reviewers did not raise any additional concerns about the Hungry Horse facility. 

At the Columbia Falls facility, however, inspectors flagged additional instances of clients being transported and admitted while under the influence, including a situation where a patient left the facility, returned inebriated three hours later and subsequently threatened staff and patients. That patient was reportedly asked to leave the facility five days later, according to an excerpt of the clinical director’s note included in the state inspection.

Driscoll said Thursday that the situation was investigated, dealt with and reported to the state after a thorough review by staff. 

State reviewers in January also found that the facility erred in not reporting another serious incident that took place at the end of December. At that time, inspectors said, two men at the facility tied a noose using “parachute cord” and dangled it outside a Black male client’s window, resulting in a “verbal altercation” between the three patients. 

The next day, the report said, the clinical director recommended the two men involved in making the threat “be discharged from the program in order to protect the future and current clients.” State inspectors later said that recommendation was not heeded by an unnamed co-CEO, who “spoke with all clients involved in the incident and determined that all clients would be allowed to stay at the facility.”

Driscoll, who identified himself as the co-CEO involved, said he was “disgusted” by the clients’ actions but said the state’s description of how the situation ended was inaccurate. After meeting with all patients involved, Driscoll said, the Black male client decided he was comfortable with the other two patients remaining at the facility and ultimately “rose above” the situation. He added that the clients in that situation would not have been allowed to remain if the victim had not been “100% comfortable.”

Driscoll also said the facility was challenging the state’s determination of that action as a “serious incident” that required an immediate report to the health department.

“We immediately responded to the situation,” he said. “That’s the most important part.”