Mismanaged Methadone Program and Parties Behind It
by Marvin Pirila
Is the Volunteer Services of Carlton County (VSCCI) really interested in helping methadone addicts or simply profiting from it?
The net profit of operations shows what a lucrative business this has become for VSCCI:
January 2014: $90,375
Six months: $649,460 [After all expenses are accounted for]
At its current profit margin, the VSCCI will make more than $1.3 million in net profits on transportation in 2014 alone. The majority of these earnings are from the transport of methadone clients to a local clinic as well as to Brainerd, St. Cloud, and St. Paul.
By its’ own definition, Volunteer Services of Carlton County is a non-profit service provider and advocate working to improve the quality of life in our community. As a “non-profit” provider, they are posting profits that any for-profit company would envy. While they bank big dollars from Medica, UCare, Blue Plus, County, and County SB, they continually pursue and receive grant money. This has become a money making machine that preys upon the unwitting taxpayer.
For the period mentioned above, January through June of 2014, VSCCI received the following monies from taxpayer funded accounts:
-Blue Plus: $27,367
-County SB: $31,698 [SB is Special Billing - services offered for county employees covered by their health plan]
The numbers beg the question, why are VSCCI and other organizations allowed to bill the insurance companies and the county more than twice their actual costs? As taxpayers are gouged more and more, particularly in the form of property taxes, this is the kind of waste routinely discovered. Where is the state and county oversight?
Even with the enormous profits generated every month, the Volunteer Services of Carlton County’s own mission statement states they are “committed to utilizing volunteers of all ages to meet the needs of older adults and disabled individuals in our communities.” On one hand, they reap a fortune in profits on one venture and on the other provide services via unpaid volunteers.
Despite claims they are dependent on grants, donations and fundraisers for operational costs, their budget suggests otherwise.
Messages left by the Floodwood Forum with VSCCI Director Jill Hatfield requesting comments and interview were not answered.
Capitalizing on Grants/Donations while Cashing in on Transportation
Reaping the benefits of a non-profit organization, while banking huge sums of money leaves one wondering where the money ultimately goes. Does a non-profit that earns $1.3 million in net profits need grants and donations?
Volunteer Services receives funding from several sources:
-Carlton County Corporation for National and Community Service
-Lake Country Power
-Minnesota Department of Human Services (CS/SD Grant)
-Minnesota Board on Aging
-United Way of Carlton County
-ARDC Arrowhead Area Agency on Aging as a part of the Older American Act Program under an Area Plan approved by the Minnesota Board on Aging
Inquiry by the Attorney General’s Office
The Minnesota Attorney General’s Office requested all documents regarding transportation costs for VSCCI from January of 2012 to the present time in August of this year. The findings should not be a surprise to them or anyone else that has followed those cashing in on transporting methadone patients.
This inquiry came after the Carlton County Attorney’s Office passed on the opportunity to investigate and referred the matter to the Attorney General’s Office. Why is the County Attorney failing their legal duty to investigate the misuse of county funds, specifically tax dollars? The problems with this office will require its own article.
The Northland leads in methadone-involved deaths
The Minnesota Department of Health (2001-2010) reported that the counties of Carlton, Aitkin, Itasca, and St. Louis were ranked 1st (11), 7th (2), 10th (2), and 11th (5), respectively, in the state for methadone-involved deaths [Number of deaths in parenthesis]. The 41 counties included in the statistics reported a total of 377 deaths, accounting for 0.7 deaths per 100,000 residents. Our local counties accounted for 39 or 10.3% of the deaths and an average of 1.5 deaths per 100,000 residents, more than twice the state average.
Methadone for Life
Dr. Robert Newman of New York, who has worked in addiction treatment for 40 years said methadone shouldn’t be consider a cure but a maintenance drug, much like giving insulin to diabetics or medication to an epileptic.
The big difference is that insulin isn’t brought to the street and sold, nor does it have the same addictive properties. If methadone is going to be given for life, let it be given responsibly. There should be no take-homes, period. If it doesn’t leave the doctor’s office it can’t be sold or used improperly.
Failed Treatment Plan
The numerous violations at methadone clinics and minimal or missing fines show that the program is seriously flawed. Among these:
-Clients not properly assessed for treatment (no fine)
-Program provided false information to investigators; some counselors were not licensed (fine: $1,100)
-Counselors were supervising more than 50 clients at time (no fine)
-Patient given take-home doses of methadone despite failing of a drug screen (no fine)
-Group counseling not being offered (no fine)
-Program knowingly provided false information to investigators; client files were falsified (fine: $900)
-Client files did not include documentation of treatment progress (no fine)
Clinics were cited for over 250 violations from 2007 to 2012 even though most were given advance notice of the inspections. State laws dictate the amounts DHS can fine.
The charges of providing false information should have led to criminal charges, in addition to the fines. Failing to properly assess and treat clients could very well lead to liability issues for the clinics as shown by the courts decision to let Pinnacle Recovery Services be included in a lawsuit for dosing a client who appeared high.
The fines, set by state law, are negligible and do little to enforce compliance with the treatment program guidelines. The lack of appropriate enforcement measures, including significant fines, is a leading factor for non-compliance. The losers are the clients who honestly seek treatment and taxpayers who pay for a known, broken system.
The Department of Human Services (DHS) Lacks Accountability
In its in-depth investigation, the Duluth News Tribune found that clinics can go years between state inspections. DHS administrators said they have no statutory requirement for how often clinics must be inspected.
When the DNT asked if DHS had a study measuring the effectiveness of methadone treatment in Minnesota, the agency acknowledged it did not. No program is complete without some form of measurement. How do you strive for success when you have no idea what success looks like?
The ‘DHS doesn’t track the costs for transportation to methadone clinics,” said agency spokeswoman Karen Smigelski (Duluth News Tribune, 9/1//12). How many businesses are exempt from reporting all financial facets of their operations? Worse yet, how many can remain oblivious to exploding costs, all on the backs of taxpayers?
The DHS is deficient in tracking the expenses and effectiveness of the methadone treatment program. In effect, they are responsible for creating the windfall profits that entice both profit and non-profit organizations to jump in to reap their own fortunes. Their failure to professionally manage the program has left the blood of many on their hands. Additionally, they are responsible for the many new users who now have additional sources of methadone.
The costs are very high and increasing
The DNT found that taxpayers spent $43 million from 2005 to 2011 to supply methadone to people who don’t have private insurance. This doesn’t include transportation costs that appear to be significantly higher than the treatment costs.
It get's worse, much worse
When the Duluth News Tribune did its in-depth research on methadone, they reported that only 5% of clients completed the program. Others believe this percentage is exaggerated and is actually less.
Suppose for a moment that we accept the 5% ratio. Every year as thousands of new people enter treatment, only 5% of them have the reasonable expectation of completing the program. The program continues to grow endlessly in size, feeding both non-profits like VSCCI and for-profits like Colonial Management. This is not only big business, it's a no lose, endless win situation, all paid for by taxpayers.
Any time you can retain virtually all of your current clients, while continually adding more that you will keep indefinitely, you have an infinite money train.
There is little-to-no effort to stop the influx of new clients either. Sales of unused doses facilitated by allowing take-home doses guarantees still more people for future treatments. Many are seeking larger doses than they will use, just to resell it on the street for up to $1 mg. While take-home doses seem like a worthwhile reward for established clients, it is also growing the number of methadone addicts.
The Problems follow Early Quitters
There are 11 methadone clinics in Minnesota that witness between 37.3% and 54.9% of their clients leaving without staff approval. These early dropouts are responsible for an increase in arrests of between 55.2 % and 1490.8%. The average dropout rate of all clinics was 44.3% while the increase in arrests for these dropouts averaged 290.7%. These figures were taken from the Minnesota Department of Human Services for the years of 2007-2010. The police might as well get a list of all dropouts because they are more than likely to be arrested again…and again.
The average decrease in drug use, for the 5% that complete treatment, 30 days after discharge was 42.9%. After several thousands of dollars are spent on methadone treatment, a mere 6.1% decrease in continued use potential was gained. Of the 5% completing the program, 93.9% had no greater chance of staying clean.
The numbers show what a disaster this program is as currently administered. If 1,000 people entered the program, 44.3% dropped out (average) that would leave 557 individuals continuing treatment. Of the original 1,000, only 5% or 50 would complete the program. Of the 50 completing the program, only 6.1% or 3 people would be less likely to have a relapse. These three individuals, still having a great likelihood of relapse, represent just 0.003% of everyone that entered the program initially. It is safe to say that the numbers show that either you are on methadone for life or the program fails miserably. Moreover, not only does it fail, it contributes yet more and more to its own demise through making methadone more available to new users.
Better Plans are Needed
Take-home doses must be banned in order to stop its resale. It would make far more sense to have a medi-bus run routes to designated areas to serve individuals close to home, eliminating or reducing individual travel. Moreover, it would allow counselors to oversee doses taken in their presence. This would end the take-homes, stop the dealing, and eliminate methadone use by those not in treatments.
Too much money to pass up
Pinnacle Recovery will now be providing their own transportation for clients going to Brainerd for dosing. These clients must use Pinnacle's transportation to be covered under a Minnesota Health Plan for Medical Assistance.
Up to this point Medica has been paying for no-load (no passengers) miles but are suggesting they will not in the next contract period. Will it really help or will they be charged more for the passenger portion?
The lack of oversight, accountability, and personal responsibility has made methadone clinics nothing more than a facilitator of continued, growing methadone use. The DHS is negligent in its responsibilities, the County is failing to properly manage taxpayer funds, and organizations are reaping the rewards.
Is anyone really trying to successfully treat opiate addicts or are they simply trying to profit from their personal demise?